Anesthetic aspects of laparoscopic and open adrenalectomy for pheochromocytoma

Objectives. To compare the anesthetic aspects and intraoperative hemodynami c data and immediate postoperative outcomes in patients whose pheochromocyt oma resection was performed either laparoscopically or by traditional open surgery. Methods. Fourteen consecutive patients who underwent laparoscopic procedure s (a single surgeon) were compared with 20 patients who underwent open surg ery. The patients' records were reviewed for demographic information, preop erative medical history and therapy, intraoperative hemodynamic data, fluid balance, and immediate postoperative course. Results. No differences between the highest intraoperative blood pressures and number of hypertensive episodes between the two groups were found. Howe ver, in laparoscopic patients, the intraoperative hypotension was less seve re (mean lowest blood pressure 98/57 mm Hg Versus 88/50 mm Hg, P = 0.05), a nd the hypotensive episodes were less frequent (median 0 versus 2, P = 0.00 5) and required fewer interventions with vasopressors (P = 0.02). Extreme h igh and extreme low heart rates did not differ between the two groups. The estimated blood loss was lower in the laparoscopic group (P = 0.0001), but the total intraoperative fluid requirement and operative times were similar in the two groups. Patients in the laparoscopic group resumed walking earl ier (median 1.5 versus 4 days, P = 0.002) and resumed oral food intake soon er (median 1 versus 3.5 days, P = 0.0001). The median duration of hospitali zation in patients who underwent laparoscopic and open adrenalectomy was 3 and 7.5 days, respectively (P = 0.001). Conclusions. Intraoperative hemodynamic values during laparoscopic adrenale ctomy for pheochromocytoma were comparable to those of traditional open sur gery, but the patients who underwent the laparoscopic procedure had a faste r postoperative recovery. (C) 2000, Elsevier Science Inc.