ADRENALECTOMY IN THE ERA OF LAPAROSCOPY

Background. Recently laparoscopy has been described as an alternative approach for performing adrenalectomy. This study attempts to define t he frequency and indications for the various approaches to adrenalecto my including laparoscopy. Methods. From October 1992 to December 1995, 43 adrenal glands were excised from 40 patients, of whom 23 were wome n and 17 were men. Their ages ranged from 16 to 71 years. Nineteen ope rations were performed for pheochromocytoma, 10 for cortical adenoma ( CAd), 6 for aldosteronoma, 4 for adrenocortical cancer (ACC), 1 for Cu shing's disease (CD), and 1 for hemorrhagic cyst. Adrenalectomy was ac complished via a laparoscopic operation in 20 patients (8 CAds, 6 pheo chromocytomas, 5 aldosteronomas, and 1 HC) and via an open operation i n 19 patients (11 pheochromocytomas, 4 ACCs, 2 CAds, 1 CD, and 1 aldos teronoma). One patient with bilateral pheochromocytoma had an open and a laparoscopic adrenalectomy. Results. Open operations included 15 tr ansabdominal, 4 posterior, and 3 thoracoabdominal approaches for 22 gl ands. Laparoscopic operations included 17 transabdominal and 4 retrope ritoneal approaches for 21 glands. Reasons for open operations include d obesity (1), patient choice (2), failed laparoscopy (2), previous ab dominal surgery (3), extraadrenal location (5); and gland size greater than 8 cm (9). Of these cases, the two patient, choices, the two fail ed laparoscopies, and two of the three previous abdominal operations w ere appropriate for laparoscopy. Each of the posterior approaches coul d have been done laparoscopically. Conclusions. More than 60% of surgi cally treatable adrenal disease may be approached laparoscopically. Tr ansabdominal, and on occasion, thoracoabdominal approaches are indicat ed for larger adrenal lesions. Surgeons operating on the adrenal gland should be familiar with each of these various approaches for adrenale ctomy.