Experience with retroperitoneal laparoscopic adrenalectomy for pheochromocytoma

Purpose: Although laparoscopic adrenalectomy has become the preferred surgi cal treatment of benign adrenal masses, for pheochromocytoma it is limited by concerns over hypertensive events related to early access to the adrenal vein. We report our experience with retroperitoneal laparoscopic adrenalec tomy for pheochromocytoma. Materials and Methods: From January 1995 to December 1999, 21 retroperitone al laparoscopic adrenalectomies (left 12 and right 9) were performed for sy mptomatic pheochromocytoma in 11 men and 9 women 17 to 68 years old (mean a ge 46). To our knowledge pheochromocytoma was always diagnosed by increased urinary catecholamine, computerized tomography, magnetic resonance imaging and (131)iodine iobenguane scintigraphy. Results: There were no conversions to open surgery. The operating time rang ed from 100 to 150 minutes (mean 116). Mean blood loss was 140 ml. (minimum 550), and none of the patients required transfusion. Hemorrhage due to adr enal vein injury occurred in 1 patient and was controlled intraoperatively. Average postoperative hospital stay was 3.4 days (range 1 to 12). The mean diameter of the excised masses was 38 mm. (range 15 to 70). Postoperative complications occurred in 4 cases, including hematoma in 1, trocar wound in fections in 2 and eventration in 1 after 1 year. With a mean followup of 21 .6 months (range 6 to 46), all patients had normal urinary catecholamine le vels and 18 had normal blood pressure without treatment. Conclusions: Retroperitoneal laparoscopic adrenalectomy can be safely perfo rmed for small (less than 5 cm. diameter) pheochromocytoma. Retroperitoneal laparoscopy is a direct approach that allows the surgeon to control the ad renal vein first, thereby avoiding hypertensive events.