Endoscopic retroperitoneal adrenalectomy: Lessons learned from 111 consecutive cases

Objective To evaluate the effectiveness of endoscopic retroperitoneal adrenalectomy ( ERA). Summary Background Data Minimally invasive adrenalectomy has become the procedure of choice for ben ign adrenal pathology. Although the adrenal glands are located in the retro peritoneum, most surgeons prefer the transperitoneal laparoscopic approach to adrenal tumors. Methods Clinical characteristics and outcomes of 111 ERAs from January 1994 to Dece mber 1999 were evaluated. Results Ninety-five patients underwent 111 ERAs (79 unilateral, 16 bilateral). Indi cations were Gushing syndrome (n = 22), Cushing disease (n = 8), ectopic ad renocorticotropic hormone syndrome (n = 6), Conn's adenoma (n = 25), pheoch romocytoma(n = 19), incidentaloma (n = 11), and other (n = 4). Tumor size v aried from 0.1 to 8 cm. Median age was 50 years. Unilateral ERA required 11 4 minutes, with median blood loss of 65 mL. Bilateral ERA lasted 214 minute s, with median blood loss of 121 mL. The conversion rate to open surgery wa s 4.5%. The complication rate was 11%. Median postoperative hospital stay w as 2 days for unilateral ERA and 5 days for bilateral ERA. The death rate w as 0.9%. At a median follow-up of 14 months, the recurrence rate of disease was 0.9%. Conclusion For benign adrenal tumors less than 6 cm, ERA is recommended.