RETROPERITONEAL LAPAROSCOPIC ADRENALECTOMY FOR FUNCTIONING ADRENAL-TUMORS - COMPARISON WITH CONVENTIONAL TRANSPERITONEAL LAPAROSCOPIC ADRENALECTOMY

Purpose: We attempted to confirm the possibility and feasibility of la paroscopic adrenalectomy via the retroperitoneal approach, and to comp are results of the transperitoneal and retroperitoneal approaches. Mat erials and Methods: Three men and 8 women (mean age 39.6 years) with f unctioning adrenocortical tumors (primary aldosteronism in 5 and Cushi ng's syndrome in 6) underwent laparoscopic adrenalectomy via the retro peritoneal approach using a balloon dissection technique and a newly d eveloped ultrasonic aspirator. Results were compared to those of 27 ca ses of transperitoneal laparoscopic adrenalectomy. Results: Although t he retroperitoneal approach was successful in all 5 patients with prim ary aldosteronism, it succeeded in only 2 of the 6 cases of Cushing's syndrome. In 3 Cushing's syndrome cases the retroperitoneal approach w as changed to the transperitoneal laparoscopic approach due to difficu lty in exploration. Open laparotomy was required in 1 case of left Gus hing's syndrome because of an inadvertent pancreatic injury. Subcutane ous emphysema developed in 6 patients without hypercapnia or prolonged postoperative symptoms. Mean operative time and blood loss, and time to oral intake and ambulation were 248.3 minutes, 151.4 mL, and 1.55 a nd 2 days, respectively. There was no difference between retroperitone al and conventional transperitoneal laparoscopic adrenalectomy in rega rd to these factors or to convalescence. Conclusions: Retroperitoneal laparoscopic adrenalectomy is feasible for primary aldosteronism. Howe ver, Gushing's syndrome is presently a much more difficult indication than primary aldosteronism for this new operative technique.