LAPAROSCOPIC TRANS-PERITONEAL ADRENALECTOMY - A PRELIMINARY-REPORT OF14 ADRENALECTOMIES

OBJECTIVES Laparoscopic adrenalectomy offers the potential benefits of a smaller operation with more rapid hospital discharge, compared to o pen surgery. Only a few small series have been reported so far. We des cribe our preliminary experience of 14 adrenalectomies using this new technique. DESIGN Review of all adrenalectomies (with the pre-operativ e intention of laparoscopic removal) performed in an endocrine unit wh ose surgeon already had abdominal laparoscopic experience, particularl y with cholecystectomy. PATIENTS AND MEASUREMENTS Twelve patients (3 w ith Conn's syndrome, 3 Cushing's syndrome, 1 Cushing's disease, 2 phae ochromocytomas and 3 adrenal incidentalomas) were operated between Sep tember 1993 and February 1996. Operating times, operative technique, t ime from surgery to discharge, outcome and all complications were reco rded prospectively. Comparative data were obtained from 14 consecutive open adrenalectomies performed by the same surgeon between February 1 989 and February 1995. RESULTS Fourteen glands were removed, two with a cholecystectomy, in 12 operations. Operating time (mean (range) 120 (60-225) min) was reduced with experience. Positioning the patient in the right lateral position facilitated left adrenalectomy. Time to dis charge (mean (range)) was 5.3 (1-12) days. There were relatively minor complications in three patients, including two with Cushing's syndrom e: a hernia at a port site, intra-peritoneal/wound haemorrhage and a p ressure sore. Time to discharge for open adrenalectomy (mean (range)) was 6.5 (2-11) days and one case was complicated by wound infection. C ONCLUSIONS Laparoscopic adrenalectomy is a practical technique for app ropriately trained surgeons who regularly undertake adrenalectomy. The smaller incisions offer potential advantages, particularly for patien ts with poor tissue quality due to Cushing's syndrome, but tissue haem orrhage may still be a problem in these patients. Time to hospital dis charge was similar to that for open surgery.