LAPAROSCOPIC ADRENALECTOMY - HISTORY, INDICATIONS, AND CURRENT TECHNIQUES FOR A MINIMALLY INVASIVE APPROACH TO ADRENAL PATHOLOGY

Refinements in the field of laparoscopic general surgery have not only made the performance of laparoscopic adrenalectomy technically feasib le, but have evert made it the preferred method of treatment for benig n adrenal pathology, The advantage of the laparoscopic approach lies i n the fact that it allows precise, hemostatic dissection of the gland in a minimally invasive fashion, We present here the results of publis hed reports of laparoscopic adrenalectomy as well as our own experienc e, and compare these data with reports from open procedures. The indic ations for the surgical removal of the adrenal gland have not changed, and include: endocrine active tumors, suspected malignancies, adrenal masses larger than 6 cm, and masses that have been followed and obser ved to be growing, Laparoscopic adrenalectomy can be accomplished with one of three approaches: anterior, lateral and posterior. Each approa ch has advantages and limitations, and our preferences are discussed. The general techniques are briefly described. The findings from many s tudies show that the blood loss, operative complications, hospital sta y and recovery period are significantly reduced with the laparoscopic approach. Based on our experience with 19 laparoscopic adrenalectomies and a review of the current literature, laparoscopic adrenalectomy ca n be fairly described as the current ''gold standard'' treatment for b enign adrenal disease. Patients benefit from short hospital stays, low er morbidity, and a more rapid recovery. The only question that remain s is the appropriateness of laparoscopic adrenalectomy in the treatmen t of adrenal malignancy, and the answer to this will depend on the res ults of long-term outcome studies.