Lateral transperitoneal laparoscopic adrenalectomy

Several laparoscopic approaches to the adrenal gland have been described. T he lateral transperitoneal approach has several distinct advantages when co ntrasted with other techniques for laparoscopic adrenalectomy (LA). We pres ent our technique and results obtained in 50 consecutive transperitoneal LA s. We review 50 consecutive laparoscopic adrenalectomies (28 female, 19 mal e) performed from 1993 to 1998. S.J. Shichman or R.E. Sosa was either the p rimary surgeon or the first assistant for all cases. The lateral transperit oneal approach described below was used in all cases. Indications for adren alectomy included Gushing's syndrome (13), aldosteronoma (15), pheochromocy toma (7), nonfunctioning adenoma (11), hyperplasia (2), and 1 case each of Carney's syndrome and metastasis to the adrenal gland. We performed 5 bilat eral, 22 left, and 18 right laparoscopic adrenalectomies. The average time needed for bilateral adrenalectomy was 503 min (range 298-690 min): for lef t adrenalectomy, 227 min (range 121-337 min); and for right LA, 210 min (ra nge 135-355 min). We demonstrated a yearly trend in lower operative times. The largest adrenal gland removed measured 13.8 x 6.7 x 3.5 cm. Intraoperat ive blood loss was low. Only one patient received a blood transfusion. Conv ersion to open adrenalectomy was not required. Postoperative analgesic requ irements were low. The average length of stay was 3.8 days for bilateral LA and 3 days for unilateral LA. Complications occurred in 5 patients (2 woun d infections, 2 hematomas, and 1 pleural effusion). There was no mortality. Lateral transperitoneal adrenalectomy is a safe and efficient technique fo r the removal of functional and nonfunctional adrenal masses. This techniqu e is associated with low morbidity, a minimal postoperative analgesic requi rement, and a short hospital stay and, in our opinion, is more versatile th an the retroperitoneal approach.