EARLY EXPERIENCE WITH LAPAROSCOPIC APPROACH FOR ADRENALECTOMY

Background. Adrenalectomy performed by a posterior or transabdominal a pproach causes substantial postoperative pain. The purpose of this stu dy was to evaluate laparoscopy as a potential approach for adrenalecto my. Methods. We performed 25 consecutive laparoscopic adrenalectomies on 22 patients from April 1, 1992, to March 30, 1993. Laparoscopic sur gery was performed by using a lateral decubitus flank approach with fo ur 11 mm trocars. Results. Twelve right and 13 left adrenal glands wer e removed in a mean time of 2.3 hours. Three patients underwent bilate ral adrenalectomies in a mean time of 5.3 hours. The 15 women and 7 me n range in age from 31 to 60 years (mean, 42 years). The adrenal gland diseases were nonfunctional adenoma (seven), pheochromocytoma (five), Cushing's disease (four), Cushing's adenoma (four), primary aldostero nism (two), dehydroepiandrostenedione sulfate hypersecretion (one), an giomyolipoma (one), and medullary cyst (one). Average tumor size was 4 .1 cm (range, 1 to 15 cm). Laparoscopic adrenalectomy was successful i n 96% of patients, with one patient requiring a laparotomy because of inadequate exposure. The median postoperative stay was 4 days (range, 2 to 19), with a mean of five narcotic injections. There were no death s, and morbidity was minor. Conclusions. Laparoscopy can be used succe ssfully for adrenalectomy. It produces less postoperative pain and rap id return to normal activity. It may be the preferred method for remov ing most adrenal gland lesions that require operation.