SUBTOTAL ADRENALECTOMY BY THE POSTERIOR RETROPERITONEOSCOPIC APPROACH

The retroperitoneoscopic approach offers an established operative proc edure for primary adrenal gland tumors. It allows a detailed view of t he adrenal gland and its surrounding region. Therefore clear different iation between normal and neoplastic adrenal tissue is sometimes possi ble, permitting a planned, unilateral, subtotal resection of the gland . Between July 1994 and August 1997 primary benign adrenal gland tumor s (11 Conn adenomas, 4 pheochromocytomas, 4 Gushing adenomas, 3 hormon ally inactive tumors; 2.4 +/- 1.2 cm in size; 8 on the right, 14 on th e left) were removed from 22 patients by the posterior retroperitoneos copic approach maintaining tumor-free portions of the ipsilateral adre nal gland. Two patients suffered from bilateral pheochromocytomas asso ciated with multiple endocrine neoplasia (MEN-IIa) syndrome and had pr eviously undergone complete adrenalectomy of the contralateral gland. Following subtotal resection the operating time and blood loss did not differ significantly (p > 0.05) from that seen with complete extirpat ion (46 patients operated during the same period). All patients with C onn adenomas and pheochromocytomas were biochemically and clinically c ured (follow-up 11 months; range 1-31 months). The four patients with Gushing adenoma currently require decreasing cortisol substitution. In the two MEN-II patients adrenal gland cortical function could be main tained; one patient is on low-dose steroid supplementation and the oth er on none. No local recurrence of tumors has been observed. In select ed cases the retroperitoneoscopically performed subtotal adrenal gland resection is a safe procedure that can potentially maintain the funct ion of the adrenal gland cortex.