LAPAROSCOPIC ADRENALECTOMY - COMPARISON OF THE LATERAL AND POSTERIOR APPROACHES

Objective: To compare the lateral transabdominal and posterior retrope ritoneal laparoscopic methods for performing adrenalectomy. Design: No nrandomized. Setting: Hospitals affiliated with the University of Cali fornia, San Francisco. Patients: Thirty-six patients (15 men and 21 wo men), aged 5 to 78 years (mean age, 49 years), were treated for the fo llowing conditions: aldosteronoma, 18 patients; pheochromocytoma, 4 pa tients; Gushing syndrome, 6 patients; androgen-secreting tumor, 1 pati ent; nonfunctioning adenoma, 3 patients; adrenal hemorrhage, 1 patient ; metastatic neoplasm, 2 patients; and myelolipoma, 1 patient. Interve ntions: Twenty-three lateral and 14 posterior laparoscopic adrenalecto mies. Main Outcome Measures: Success rate, operating time, complicatio ns, and length of hospital stay. Results: The tumors, which ranged in size from 1 to 13 cm (mean, 4.2 cm; median, 2.5 cm), were all successf ully resected laparoscopically. All 8 tumors larger than 6 cm were res ected by the lateral approach. One critically ill patient died. No pat ient required blood transfusions or conversion to laparotomy. Mean ope rating time was 3.8 hours vs 3.4 hours (median, 3.5 hours vs 3 hours) and mean hospital stay was 2.2 days vs 1.5 days (median, 2 days vs 1 d ay) for the lateral and posterior approaches, respectively. AII patien ts without concomitant procedures were ready to be discharged within 4 8 hours. Conclusions: Both approaches were effective and safe. We pref er the lateral approach for tumors larger than 6 cm and tile posterior approach for bilateral tumors.