Eight-year experience with transperitoneal laparoscopic adrenal surgery

Purpose: Laparoscopic adrenalectomy is currently the technique of choice fo r removing benign adrenal lesions. Various laparoscopic techniques and appr oaches have been reported using the transperitoneal or retroperitoneal appr oach. We present our 8-year experience with and longterm results of transpe ritoneal laparoscopic adrenalectomy. Materials and Methods: Between October 1992 and October 2000, 161 laparosco pic approaches to the adrenal gland were performed, including 145 unilatera l and 10 bilateral adrenalectomies, and 6 conservative operations. Patients were placed in the 60-degree flank position with the bed flexed to increas e the surgical field. To avoid hypertensive crisis, especially in patients with pheochromocytoma, the first step involved early ligation of the adrena l vein. Results: The laparoscopic procedure was succesfully completed in all except 4 cases, which were converted to open surgery. Mean operative time was 160 minutes in the unilateral, 245 in the bilateral and 90 in the conservative group. Delayed complications included hemoperitoneum in 3 patients, which was drained surgically, severe blood loss in 3 treated with blood transfusi on and wound infection in 2. Patients were ambulatory on the morning of pos toperative day 1 and were discharged home 2.8, 5 and 1.8 days after unilate ral, bilateral and conservative surgery, respectively. Conclusions: Laparoscopic transperitoneal adrenalectomy is a safe, effectiv e, minimally invasive approach in patients with benign functioning or nonfu nctioning adrenal masses. This technique involves low morbidity, minimal po stoperative analgesic requirements and a short hospital stay.