Complications of laparoscopic and retroperitoneoscopic adrenalectomies in 370 cases in Japan: a multi-institutional study

A total of 370 laparoscopic adrenalectomies, including 311 transperitoneal (TP) and 59 retroperitoneal (RP) approaches, were performed in nine urologi c centers, where the laparoscopic adrenalectomy was first begun independent ly in Japan, and their affiliated hospitals between January 1992 and Septem ber 1996. The clinical diagnoses of those 370 adrenal diseases were primary aldosteronism in 155 patients, Gushing's syndrome in 61, preclinical Gushi ng's syndrome in 21, pheochromocytoma in 16, nonfunctioning adenoma in 87, complicated cyst in ten, myelolipoma in nine, adrenal cancer in four and ot her diagnoses in eight (table I). There was no mortality in this series. In traoperative complication rate was 33/370 (9%) in total: 26/311(8%) in the TP procedures and 7/59 (12%) in the RP procedures (table II). Postoperative complication rate was 24/370 (6%) in total: 22/311 (7%) in the TP procedur es and 2/59 (3%) in the RP ones (table III). Conversion rates to open surge ry in total, in the TP and in the RP procedures were 13/370 (3.5%), 10/311 (3.2%) and 3/59 (5.1%), respectively (table IV). Although the RP procedure has a lower morbidity rate compared to the TP procedure, more skill is requ ired to overcome the drawback of the narrow working space and fewer anatomi cal landmarks. (C) 2000 Editions scientifiques et medicales Elsevier SAS.