Six of the Best, Upper GI 18

Abstract

Aims: To report our experience with laparoscopic transperitoneal adrenalectomy. Methods: From November 1993 to August 2000, 151 laparoscopic adrenalectomies were attempted in 132 patients who presented with symptomatic adrenal masses or who had an incidental large mass diagnosed during investigations for other complaints. All perioperative and follow-up data was prospectively recorded on a dedicated unit database. Results: The median age was 52 years (18–77 years). Seventy-six per cent were female. Lesions were left-sided in 48 per cent of patients and bilateral in 14 per cent. Indications for resection were: Conn's syndrome (54), phaeochromocytoma (27), Cushings disease (13), nonfunctioning adenoma (14), congenital adrenal hyperplasia (2), cortisol-producing adenoma (5), combined Cushings and Conn's syndrome (1), primary or metastatic carcinoma (7), benign cyst/lipoma (8), and no lesion (1). Median size of the lesions was 3.0 cm (0.5–20 cm). Median operating time was 65 min (30–170 min). Conversion to an open procedure was necessary in 10 patients (8 per cent). Minor morbidity occurred in nine patients (7 per cent). Major morbidity occurred in two patients (pancreatitis, peritonitis). Median hospital stay was 3 days (1–16 days). At median follow up of 28 months (1–94 months), five patients (4 per cent) had persistent hypertension. No patient had evidence of recurrent hormonal excess. Conclusions: Laparoscopic removal of the adrenal gland should be considered the surgical procedure of choice in experienced centres. It requires a high degree of technical expertise and should remain within the remit of the advanced laparoscopic surgeon.