LAPAROSCOPIC ADRENALECTOMY COMPARED TO OPEN ADRENALECTOMY FOR BENIGN ADRENAL NEOPLASMS

BACKGROUND: Laparoscopic adrenalectomy has recently been used for remo ving a variety of adrenal neoplasms. The purpose of the present study was to compare results and outcomes in patients who underwent either l aparoscopic or open adrenalectomy at our institution from 1988 to the present. STUDY DESIGN: The records of 66 consecutive patients with ben ign adrenal neoplasms who underwent adrenalectomy from 1988 through 19 95 were retrospectively reviewed. Patients were divided into three gro ups based on the operative approach: group I (n=25), open anterior tra nsabdominal approach; group II (n=17), open posterior retroperitoneal approach; and group III (n=24), laparoscopic transabdominal flank appr oach. Various parameters were compared and statistical analyses were p erformed. RESULTS: The three groups were similar in age, gender. Ameri can Society of Anesthesiologists class, and distribution of unilateral compared with bilateral adrenalectomy. Mean tumor size was slightly l arger in group I (3.4+/-1.4 cm) than in group II (2.4+/-1.4 cm) or gro up III (2.7+/-1.4 cm) (p=NS). Mean operative times for unilateral adre nalectomy were 142+/-38 minutes in group I, 136+/-34 minutes in group II, and 183+/-35 minutes in group III (p<0.001, groups I and II compar ed with group III). For bilateral adrenalectomy, mean operative times were 205+/-71 minutes (group I), 328+/-11 minutes (group II), and 422/-77 minutes (group III). Patients who underwent laparoscopic adrenale ctomy had significantly less operative blood loss (mean, 104 mL compar ed to 408 mL in group I and 366 mL in group II, p<0.001) and a lower i ncidence of perioperative blood transfusion. Laparoscopic adrenalectom y was also associated with significantly reduced parenteral pain medic ation requirements (p less than or equal to 0.001) and more rapid resu mption of a regular diet (p less than or equal to 0.01) compared to op en adrenalectomy. Postoperative length of stay was significantly longe r in group I (8.7+/-4.5 days) and in group II (6.2+/-3.9 days) after o pen adrenalectomy than after laparoscopic adrenalectomy (3.2+/-0.9 day s) (p<0.01). Total hospital charges were similar for groups II and III but somewhat higher for group I. Patients were able to resume 100 per cent activity an average of 10.6+/-4.9 days after laparoscopic adrenal ectomy and returned to work a mean of 16.0+/-6.1 days postoperatively. CONCLUSIONS: Laparoscopic adrenalectomy is a safe and effective proce dure and has several advantages over open adrenalectomy. Laparoscopic adrenalectomy should become the preferred operative approach for the t reatment of patients with small, benign adrenal neoplasms.