LAPAROSCOPIC ADRENALECTOMY - THE IMPORTANCE OF A FLANK APPROACH IN THE LATERAL DECUBITUS POSITION

Adrenalectomy is usually performed via transabdominal or posterior app roaches. Unfortunately, both approaches are associated with painful po stoperative syndromes. Recently, laparoscopic surgery was applied to o rgan removal. During a period of 12 months, we performed a series of s uccessful laparoscopic adrenalectomies (10 of the right and 11 of the left gland). The pathologies were medullary cyst (1), angiomyolipoma ( 1), DHEAS hyperplasia (1), primary aldosteronism (2), Cushing's adenom a (3), pheochromocytoma (4), Cushing's syndrome (4), and nonfunctional adenoma (5). A flank approach was taken with four 11-mm trocars. Elec trocautery and blunt forceps were used for dissection. The vessels wer e secured with medium-large titanium clips, and the adrenal was remove d in a sterile plastic bag. The average operating time was 2.3 h, and median postoperative stay was 4 days. Two patients required blood tran sfusion of 2 units postoperatively. We believe this technique is adequ ate for the surgical removal of adrenal tissue, resulting in less post operative pain and in rapid recovery. It may also change the surgical management of asymptomatic adrenal lesions.