Laparoscopic transperitoneal anterior adrenalectomy.

Abstract

AIM:

Aim of this study was to report the authors' experience with the anterior transperitoneal approach, and with an anterior submesocolic approach in case of left sided lesions.

MATERIAL AND METHODS:

From January 1994 to January 2011, 122 males and 170 females with a mean age of 50.7 years (range: 19-84) underwent laparoscopic adrenalectomy (LA) at 2 centers in Ancona and Rome (Italy) (that follow the same protocol). Fifteen patients underwent bilateral LA, the anterior transperitoneal approach was used in 233 cases (79.8%) and the anterior submesocolic in 59 (20.2%). One hundred and two patients had Conn's syndrome, 51 miscellaneous lesions, 55 Cushing's syndrome, 47 incidentalomas, 46 pheochromocytoma, 2 metastatic masses, 2 myelolipomas and 2 adrenogenital syndromes. The lesions had a mean diameter of 3.24 cm (range: 0.5-10).

RESULTS:

Mean operating time was 120 minutes (range: 30-390). Conversion to open surgery was required in 13 cases (4,45%). Blood pressure and heart rate were stable during the operation. There were 5 major complications. Mobilization and resumption of diet occurred on the first postoperative day. Mean hospital stay was 4.32 days (range: 2-30).

DISCUSSION:

Early identification and ligature of the adrenal vein, with minimal gland manipulation, are the major advantages, especially in case of pheochromocytoma.

CONCLUSIONS:

Adrenal masses can be successfully treated using a laparoscopic transperitoneal anterior approach, in presence of a suitable anesthesiological and surgical team's experience.

KEY WORDS:

Adrenal tumors, Laparoscopic adrenalectomy, Pheochromocytoma.

• Authors: Daniele Scoglio, Andrea Balla, Marcello Paci, Mario Guerrieri, Giovanni Lezoche, Giancarlo D'Ambrosio, Bernardina Fabiani, Pietro Ursi, Alessandro M Paganini
• Journal: Annali italiani di chirurgia (Ann Ital Chir) 2013 Jul-Aug Vol. 84 Issue 4 Pg. 411-6 ISSN: 2239-253X [Electronic] Italy
• PMID: 23917215 (Publication Type: Journal Article)

Topics

• Adrenal Gland Neoplasms (surgery)
• Adrenalectomy (methods)
• Adult
• Aged
• Aged, 80 and over
• Female
• Humans
• Laparoscopy
• Male
• Middle Aged
• Young Adult