LAPAROSCOPIC ADRENALECTOMY - THE RETROPERITONEAL APPROACH

Purpose: Retroperitoneal laparoscopy, by providing direct access to th e retroperitoneal cavity, is an interesting approach to urological sur gery. We report our initial experience with retroperitoneal laparoscop ic adrenalectomy. Materials and Methods: Between January 1995 and Apri l 1997, 23 adrenalectomies were performed by retroperitoneal laparosco py in 10 men and 12 women. The patients were placed in the lateral dec ubitus position and 5 trocars were used. The retroperitoneal working s pace was created by digital dissection and was completed by insufflati on without balloon dissection. The surgical indications were Conn's ad enoma in 12 cases, Gushing's adenoma in 4, bilateral adrenal hyperplas ia (Cushing's disease) in 1 (treated in a single procedure), a nonfunc tioning adenoma in 2, pheochromocytoma in 2 and adrenal metastasis in 1. Results: We removed 7 right and 16 left adrenal glands in an averag e operating time of 97 minutes (range 45 to 160). Average tumor size w as 26 mm. (range 10 to 40). Average hospital stay was 3.3 days (range 1 to 10). Blood loss was minimal. Postoperative analgesic requirements were moderate. Conversion to open surgery was not necessary. The morb idity rate was low, with 1 postoperative hematoma and 1 case of persis tent fever (greater than 38.5C). Conclusions: Retroperitoneal adrenale ctomy is a reliable and effective technique. At our institution retrop eritoneal laparoscopy is now the standard adrenal surgery procedure fo r tumors less than 5 cm.