Small
hormone-active benign
tumors are considered as clear indication for laparoscopic
adrenalectomy. Laparoscopy resection of
pheochromocytomas is still a controversial issue, but recent data have shown that the specific risks of
pheochromocytoma surgery are not increased by the laparascopic approach. The majority of endoscopic
adrenalectomies are performed via the transperitoneal route, but there is growing interest in the retroperitoneoscopic approach. The advantages and disadvantages of each endoscopic approach have to be weighed carefully, but the final decision will also depend on the experience of the surgeon. Several retrospective studies have compared laparoscopy with open surgery. There is general agreement that laparoscopy is superior to open surgery since it is associated with less
pain, a shorter
hospital stay, and more rapid return to normal activities, and also yields the best cosmetic and long-term results. Partial
adrenalectomy may be indicated for bilateral
pheochromocytoma, and also has advantages for patients with
aldosterone-producing
adenomas. The feasibility of laparoscopic partial
adrenalectomy has been demonstrated. Laparoscopic intraoperative ultrasonography is valuable in selected cases. The already low morbidity of laparoscopic
adrenalectomy can be reduced further by using needlescopic techniques.