Laparoscopic adrenalectomy: New gold standard

Nearly 600 cases of laparoscopic adrenalectomy have been described in the w orld literature, documenting the safety and effectiveness of the procedure. Comparative studies have demonstrated the advantages of the laparoscopic a pproach when compared to traditional open approaches to adrenalectomy, docu menting a more rapid and comfortable recovery, shorter hospitalization, and fewer complications. Several techniques of laparoscopic adrenalectomy have been described. We prefer the transabdominal approach in the lateral decub itus position. Herein we report our experience with 28 adrenalectomies usin g this approach. Indications for adrenalectomy have been hyperaldosteronism (9), hypercortisolism (4), pheochromocytoma (3), incidentaloma (6), metast asis (3), lymphoma (1), angiomyolipoma (1), other (1). Average tumor size w as 3.3 cm (1.4-8.3 cm). Average operative time was 152 minutes (110-210 min utes), with left adrenalectomy taking slightly longer to perform than on th e right (156 vs. 145 minutes). There were no intraoperative complications a nd one conversion to open adrenalectomy for a Large metastatic lung cancer found to be invading the liver. One patient experienced left rib pain from a cannula site immediately at the costal margin. There were no other compli cations. Average length of hospitalization was 2.3 days (1-6 days). With th is and others' experience, laparoscopic adrenalectomy has become the gold s tandard for adrenalectomy. This manuscript reviews the literature on laparo scopic adrenalectomy and describes the transabdominal lateral approach.