TRANSPERITONEAL LAPAROSCOPIC ADRENALECTOMY - EXPERIENCE IN 100 PATIENTS

Between July 1992 and October 1996, 100 transperitoneal laparoscopic a drenalectomies were performed on 99 patients at our hospital and affil iated hospitals, The clinical diagnoses were primary aldosteronism (41 patients), Gushing's syndrome (15), pre-Gushing's syndrome (6), pheoc hromocytoma (7; 8 adrenal glands), adrenal cancer (2), nonfunctioning adenoma (22), myelolipoma (3), and complicated adrenal cyst (3), Ninet y-seven glands were removed laparoscopically. The mean operative time was 240 +/- 76 (SD) minutes and the mean blood loss 68 +/- 80 mt for t he series, The mean blood was 77 +/- 113 mt when the three operations that were converted to open surgery are included, The mean times for t he return to a normal diet and unassisted ambulation were 1.3 +/- 0.6 and 1.4 +/- 0.8 days, respectively, The mean duration of the use of an algesics was 1.5 +/- 1.3 days, including the day of surgery, In contra st, in the latest 10 open adrenalectomies done at Kyoto University Hos pital, the mean operative time was 186 +/- 53 minutes and the mean blo od loss 220 +/- 170 mt. The mean times for return to a normal diet and for unassisted ambulation and the mean duration of the use of analges ics were 1.9 +/- 0.3, 2.9 +/- 1.1, and 2.9 +/- 1.7 days, respectively, Thirty-six operations, excluding one converted to open surgery, perfo rmed at Kyoto University Hospital were selected to look at the learnin g curve for transperitoneal laparoscopic adrenalectomy and evaluated f or operative time and blood loss, The mean operative time and mean blo od loss in the first 10 procedures performed at Kyoto University Hospi tal mere 256 +/- 63 minutes and 89 +/- 57 mt; however, these values we re reduced to 177 +/- 39 minutes and 48 +/- 32 mt in the next 10 proce dures at the same hospital, Laparoscopic adrenalectomy via the transpe ritoneal anterior approach can be equivalent to open adrenalectomy in efficiency with a shorter convalescence.