Laparoscopic adrenalectomy by the anterior transperitoneal approach - Results of 108 operations in unselected cases

Background: The feasibility, safety, and results of 108 laparoscopic anteri or transperitoneal adrenalectomies (six bilateral) were evaluated in a seri es of 105 patients. Three patients with a preoperative diagnosis of primary adrenal carcinoma were excluded from the study. Methods: A total of 102 patients were included in the study based on exhaus tive endocrinological and imaging assessment. Twenty-nine patients with non secreting adenoma, 34 with aldosterone-producing adenoma, 27 with cortisol- producing adenoma (five bilateral), 13 with pheochromocytoma tone bilateral ), two with androgen-secreting adenoma, and three with metastases were cons idered eligible for adrenalectomy. Lesion size ranged from 3.5 to 12 cm. Co ncurrent surgical procedures were performed in 10 patients (9.8%). Results: One (0.9%) intraoperative complication, a colon tear in a bilatera l adrenalectomy, required conversion. There were two (1.9%) postoperative c omplications: one patient with thrombocytopenia developed hemoperitoneum an d required a second laparoscopic procedure, and an intraabdominal abscess w as treated medically. Mean postoperative hospital stay was 2.5 days (range, 1-7 days). Postoperative mortality was 0.9%; the patient with the colon te ar died of sepsis 60 days after the operation, At a mean follow-up of 30 mo nths (range, 1-62), normalization or improvement in hormone levels was obse rved in all patients with secreting adenomas, and significant improvement o r cure was achieved in all patients with hypertension. Conclusion: Patients with secreting and nonsecreting adrenal lesions can be treated safety and effectively by laparoscopy with the anterior transperit oneal approach.