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PubMed · 10922260

Laparoscopic posterior adrenalectomy: technical considerations.

A E Siperstein·E Berber·K L Engle·Q Y Duh·O H Clark
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Abstract

HYPOTHESIS: Although laparoscopic posterior adrenalectomy (LPA) offers a more direct access to the adrenal gland, it is not as popular as laparoscopic transabdominal adrenalectomy, and the worldwide experience has been limited. We hypothesized that LPA is a safe and efficacious procedure that could best serve certain patients with adrenal tumors. DESIGN: Case series of patients undergoing laparoscopic adrenalectomy in a single institution. SETTING: University teaching hospital. PATIENTS: Medical records of 31 patients with 33 tumors who underwent LPA were reviewed. Indications for operation included hormone secretion in 23 patients (74%), suspected or known malignant neoplasms in 7 patients (23%), and local symptoms in 1 patient (3%). INTERVENTION: The LPAs were performed with the patients in prone position. Preoperative ultrasonography localized the adrenal tumor and kidney to guide balloon trocar placement for the creation of a working retroperitoneal space. The LPAs were performed with three 10-mm trocars using laparoscopic ultrasound to localize the tumor and the harmonic scalpel to perform the dissection. MAIN OUTCOME MEASURES: Demographic data, type and size of tumor, operative time, blood loss, intraoperative and postoperative complications, and hospital stay were analyzed. RESULTS: All operations were successfully completed without conversion. Excluding the bilateral cases, the mean +/- SD operative time was 176 +/- 104 minutes. Estimated blood loss averaged 32 mL (range, 10-200 mL). There were no intraoperative complications. The mean +/- SD tumor size was 3.2 +/- 1.8 cm (range, 0.8-7.0 cm). Pathological evaluation revealed benign tumors in 25 patients (81%) and malignant tumors in 6 patients. The average hospital stay was 1.4 days (range, 1-3 days). There were no deaths. CONCLUSIONS: Although technically more demanding, LPA should be considered in patients with tumors less than 6 cm, bilateral tumors, or extensive previous abdominal surgery.

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Adrenal Gland NeoplasmsAdrenalectomyAdultAgedAged, 80 and overBlood Loss, SurgicalFemaleHospitalizationHumansIntraoperative ComplicationsKidneyLaparoscopesLaparoscopyLength of StayMaleMiddle AgedPostoperative ComplicationsProne PositionRetrospective StudiesSafetySurvival RateTime FactorsUltrasonic TherapyUltrasonography, InterventionalJournal Article

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A E Siperstein, E Berber, K L Engle, Q Y Duh, O H Clark. 2000. Laparoscopic posterior adrenalectomy: technical considerations.. https://doi.org/10.1001/archsurg.135.8.967

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