Posterior retroperitoneoscopic adrenalectomy: Lessons learned within five years

Posterior retroperitoneoscopic adrenalectomy is one of the new endoscopic m ethods in endocrine surgery. In a prospective clinical study 142 posterior retroperitoneoscopic adrenalectomies (72 right, 70 left) were performed in 130 patients (52 males, 78 females, age 49.1 +/- 14.9 years). Indications w ere primary adrenal tumors (unilateral, n = 118; bilateral, n = 2), adrenal metastases (n = 2), and bilateral ACTH-dependent hyperplasias (n = 10). Tu mor size ranged from 0.5 to 7.0 cm (mean 2.7 +/- 1.4 cm), Partial adrenalec tomies were performed in 39 patients. Conversion to open posterior adrenale ctomy was necessary in five patients and seven procedures (5%), Intraoperat ive and postoperative complications were minor and occurred in 5% and 13%, respectively. Mortality was zero. Operating time was 101 +/- 39 minutes (ra nge 35-285 minutes) and depended on tumor type (pheochromocytoma versus oth ers; p < 0.01), tumor size (< 3 vs. greater than or equal to 3 cm; p < 0.05 ), gender (p < 0.05), and extent of resection (partial versus complete, p < 0.05. Twenty-three adrenalectomies (17%) were performed within 1 hour or l ess. Blood loss was 54 +/- 72 ml, Consumption of analgesics was low (mean 6 mg piritramide postoperatively). Median duration of hospitalization was 3 days. Posterior retroperitoneoscopic adrenalectomy is a safe method that ha s become a standard procedure in endocrine surgery.