METHODS: A total of 32
adrenalectomies for
pheochromocytoma were performed between June 1997 and December 2009. Four
paragangliomas, operated in the same period are not included in this series. All patients were investigated and operated on using an established departmental protocol. Preoperative diagnosis, operative details, complications, length of
hospital stay, morbidity, and follow-up were documented from the hospital records of 200 patients who underwent 208
adrenalectomies for benign and malignant adrenal
tumors in the same period.
RESULTS: Thirty-two
tumors were removed from 31 patients (17 men; mean age, 54 y; range, 19 to 72 y). One patient with
MEN IIA underwent bilateral resection of
pheochromocytomas in 2 stages.
Tumor size in laparoscopic procedures ranged from 2.2 to 10.5 cm (mean, 4.97 cm).
Operative time was from 55 to 210 minutes (mean, 110 min).Twenty-seven patients had sporadic disease (2 potentially malignant, 2 malignant), and 4 in the context of a familiar syndrome (2
MEN IIA syndrome, 1
Von Hippel Lindau syndrome and Recklinghausen disease, respectively). Twenty-four patients underwent laparoscopic
adrenalectomy, 2 patients had open approach from the start for recurrent malignant
pheochromocytoma and large benign
tumor respectively, 1 patient had open approach due to inoperable malignant
pheochromocytoma, and 4 patients had conversions from laparoscopic to open procedure. All patients with
paragangliomas underwent open approach from the start. The mean
hospital stay was 2 days (range, 1 to 3 d) for the laparoscopic procedures. All patients underwent late
ligation of the main adrenal vein. Five patients received
sodium nitroprusside intraoperatively to treat
hypertension. One patient developed
pulmonary embolism after the operation, and succumbed 1 month later. There were no recurrences for the benign
tumors during the follow-up period.
CONCLUSIONS: Laparoscopic
adrenalectomy for
pheochromocytoma although safe, should be converted to open for difficult dissection, to avoid
tumor disruption, and recurrence. Hemodynamic instability can be prevented and is not influenced by early or late
ligation of the adrenal vein. Delayed main adrenal vein
ligation is a safe alternative to the "vein first" technique.