LAPAROSCOPIC ADRENALECTOMY - A NEW STANDARD OF CARE

Objectives. Adrenalectomy is the mainstay of treatment for adrenal tum ors. A variety of surgical approaches to the adrenal gland have been d escribed. We studied the feasibility of laparoscopic adrenalectomy (LA ), compared laparoscopic with open adrenalectomy (OA), and studied the hemodynamic changes in patients with pheochromocytoma. Methods. Our e arly experience with 20 consecutive LAs is compared with a contemporan eous, matched control cohort of 20 patients who underwent OA via a fla nk or subcostal incision. LA was performed via a transperitoneal appro ach, following a standardized surgical technique. Results. LA was succ essfully completed in 18 of 20 cases. Average operating time in the fi rst 5 cases was 261 minutes, but, with further experience, a significa nt decrease in operative time was seen in the last cohort of 4 patient s (155 minutes) (P = 0.0018). There was no significant difference in o perative time or degree of blood loss between LA and OA groups. Patien ts who underwent LA required lower doses of postoperative parenteral n arcotics (P = 0.0169), had a shorter hospital stay (mean 3.2 days) (P < 0.0001), and had a shorter convalescent period (mean 3.1 weeks) (P < 0.0001). Complications in the laparoscopic group (chronic port site p ain in 1 patient, intra-abdominal fluid collection in another) occurre d in the 2 patients who required open conversion. These 2 patients had large adrenal tumors (9 and 7 cm in diameter, respectively). LA resul ted in similar hemodynamic changes as OA in patients with pheochromocy toma. Conclusions. LA is a safe and effective approach in most patient s with adrenal pathology. Benefits include excellent operative exposur e and visualization, less postoperative pain, shorter hospital stay an d convalescent period, and improved cosmetic result. Pheochromocytoma is not a contraindication to LA. Patients with large adrenal tumors (l arger than 6 cm), evidence of venous involvement, or invasion into sur rounding tissue should be approached cautiously.