Transperitoneal laparoscopic adrenalectomy: Experience in 72 procedures

Purpose: To evaluate the safety and effectiveness of transperitoneal laparo scopic adrenalectomy for a variety of adrenal diseases. Patients and Methods. Seventy-two patients underwent laparoscopic adrenalec tomy from January 1995 until R larch 1999, The indications for the treatmen t were limited to either functioning or nonfunctioning adrenal masses witho ut radiologic evidence of involvement of the surrounding tissues. The indic ation for bilateral adrenalectomy was Gushing's disease after the failure o f other therapies or Gushing's syndrome secondary to ectopic ACTH secretion without the discovery of a primary neoplasm. Results: Thirty-five of the adrenalectomies were performed on the left side and 33 on the right side, and 4 were performed bilaterally, The right-side d procedures required a mean operating time of 130 minutes (range 85-200 mi nutes), the left-sided procedures required a mean operating time of 140 min utes (range 95-200 minutes), and the bilateral procedures required a mean o perating time of 240 minutes (range 210-290 minutes). A conversion from lap aroscopy to laparotomy was necessary for 3 patients (4%). Intraoperative co mplications were reported in 6 patients (8%), Postoperative complications l ikewise occurred in six patients. Conclusions. These procedures proved to be safe and able to remove the majo rity of either functioning or nonfunctioning benign adrenal masses. Some co ntroversy remains regarding the safety of laparoscopic adrenalectomy for la rge lesions and the safety of bilateral laparoscopic adrenalectomy because of bleeding risks, anesthetic risks, and long operative times. The effectiv eness of laparoscopic adrenalectomy for nonfunctioning adrenal masses with histologic findings of carcinoma has not yet been proved.