Laparoscopic transperitoneal anterior adrenalectomy in pheochromocytoma: experience in 62 patients.

Abstract

Aim was to evaluate the results in 62 patients undergoing laparoscopic adrenalectomy (LA) for the treatment of pheochromocytoma (PHE), with a transperitoneal anterior approach for lesions on the right side, and with a transperitoneal anterior submesocolic approach in case of left-sided lesions. Sixty-two patients underwent LA for the treatment of PHE at two centers in Rome and Ancona (Italy). Two patients had bilateral lesions, for a total of 64 adrenalectomies. Sporadic PHE occurred in 57 patients (91.9%) and in 5 (8.0%) it was familiar. Thirty-six patients (58.0%) underwent right adrenalectomy, 24 (38.7%) left adrenalectomy, and in 2 cases (3.2%) LA was bilateral. In 38 cases of right adrenalectomy (59.3%) and in 5 cases of left adrenalectomy (7.8%), the approach was a transperitoneal anterior one. A transperitoneal anterior submesocolic approach was used in 21 left adrenalectomy cases (32.8%). Mean operative time for right and left transperitoneal anterior LA was 101min (range 50-240) and 163min (range 50-190), respectively. Mean operative time for left transperitoneal anterior submesocolic LA was 92min (range 50-195). For bilateral adrenalectomy, mean operative time was 210min (range 200-220). Conversion to open surgery occurred in 2 cases (3.22%) due to extensive adhesions (1) and hemorrhage (1). One major and three minor complications were observed. Mobilization occurred on the first postoperative day. Hospitalization was 4.8days (range 2-19). The lesions had a mean diameter of 4.5cm (range 0.5-10). Early identification with no gland manipulation prior to closure of the adrenal vein is the main advantages of the transperitoneal anterior approach. PHE may be treated safely and effectively by a laparoscopic transperitoneal anterior approach for right-sided lesions and with a transperitoneal anterior submesocolic approach for left-sided ones.