Laparoscopic adrenalectomy: lateral transabdominal approach vs posterior retroperitoneal approach

Laparoscopic adrenalectomy has been used to remove a wide variety of adrena l neoplasms. Although several laparoscopic approaches to the adrenal gland have been described, the lateral transabdominal approach has several advant ages when compared with other approaches for laparoscopic adrenalectomy. Fr om October 1995 to July 1999, we performed laparoscopic adrenalectomies on 16 patients, including eight posterior retroperitoneal approaches and eight lateral transabdominal approaches. Sixteen patients, ranging in age from 2 3 to 69 years, were treated for the following conditions: non-functioning a denoma, four patients; aldosteronoma; seven patients; pheochromocytoma, thr ee patients; Gushing's adenoma, two patients. The average tumor size was 2. 5 +/- 0.5 cm (1.8-3.0 cm, median 2.4 cm) in the lateral transabdominal appr oach, 1.2 +/- 0.8 cm (0.8-3.2 cm, median 1.75 cm) in the posterior retroper itoneal approach. Average operative time of lateral transabdominal approach was significantly shorter than that of the posterior retroperitoneal appro aches (mean 129 min vs 269 min, P = 0.0005). Conversion to laparotomy was r equired in one patient in the posterior approach. Postoperative complicatio n occurred in one pneumothorax in the lateral transabdominal approach and t wo subcutaneous emphysemas in the posterior retroperitoneal approach. There was no statistical difference in blood loss during the operation in the tw o groups. There was no mortality in either group. The lateral transabdomina l approach is a safe and efficient technique for the removal of the adrenal neoplasms. Compared with other approaches, this technique has a wider work ing space and also good exposure for removing the adrenal gland. (C) 2000 E ditions scientifiques et medicales Elsevier SAS.