LAPAROSCOPIC ADRENALECTOMY - A REPORT ON 50 OPERATIONS

Objective: To investigate the feasibility, safety and results of lapar oscopic transperitoneal adrenalectomies performed with the patient sup ine, in patients affected by secreting and silent adrenal lesions. Met hods: Exclusion criteria were suspected adrenal primary malignancies. Fifty patients (33 women and 17 men; mean age 49.6 years, range 19-75 years) underwent 51 laparoscopic adrenalectomies (one bilateral). Afte r complete endocrinological evaluation, computed tomography or magneti c resonance imaging, or a combination thereof, 14 non-secreting adenom as, 13 aldosterune-producing adenomas, 13 cortisol-producing adenomas, eight phaeochromocytomas (one bilateral), one androgen-secreting aden oma, and two metastases were considered eligible for adrenalectomy. In five patients, associated procedures were performed during surgery. R esults: The lesions ranged in size from 1.5 to 10 cm. There were no in traoperative complications and no blood transfusions were required. Th e postoperative course was uneventful and painless in all patients. Me an postoperative hospital stay was 2.5 days. In all hypertensive patie nts, significant improvement or cure of hypertension was observed at f ollow-up (mean 18 months). In patients with secreting adenomas, normal ization of hormone concentrations was obtained after removal of the tu mour. In six patients with incidentaloma, the exaggerated 17-hydroxypr ogesterone response to ACTH disappeared after surgery. Conclusions: Se creting and non-secreting adrenal lesions were treated safely by lapar oscopy. Relatively small incidentalomas and subclinical hormonally act ive tumours can be removed by laparoscopy. Early diagnosis enhances pr evention and treatment.