Transabdominal laparoscopic approach for adrenalectomy: Experience in 169 consecutive cases

Background: Several techniques have been proposed to remove the adrenal glands laparoscopically. There is still some debate about the respective advantages and inconveniences of the transperitoneal and retroperitoneal approaches. In this study the authors report their experience with the transperitoneal flank approach. Methods: Between June 1994 and January 1999, 217 adrenalectomies were performed in our department. There were 169 laparoscopic adrenalectomies (LA) — (78 %): 61 Conn’s syndrome, 41 Cushing’s syndrome, 29 pheochromocytomas, 1 androgen producing tumor and 37 non functioning tumors. An open approach was used in 48 patients (22 %). Large and/or malignant or suspected malignant tumors (26 cases) multiple and/or extra adrenal pheochromocytomas (12 cases), previous surgery in the adrenal area (10 cases). Results: LA was unilateral in 149 patients and bilateral in 10 patients. Mean tumor size was 32 mm (7–110). Eight tumors were malignant (4.7 %). Four out of these 8 malignant tumors were completely removed laparoscopically. Conversion to open surgery was required in 8 patients (5 %). Twelve patients (7.5 %) had significant complications. There was no mortality. Mean operative time was 126 minutes (48–300) for unilateral LA and 228 minutes (175–275) for bilateral LA. The average length of hospital stay was 5.4 days (3–15). The endocrinopathy was successfully cured in all patients with functioning tumors. Conclusions: There are few absolute contraindications for LA. LA is the procedure of choice for small benign and functioning tumors. Invasive adrenal carcinoma is an absolute contraindication for LA. Nevertheless, depending on the experience of the operator, LA can be also proposed for large tumors or tumors at risk for malignancy. If local invasion is observed at the start of the procedure, LA should be immediately converted to open surgery.