Laparoscopic Adrenalectomy: A 10-year experience of 65 cases in Rajavithi Hospital
Keywords:
laparoscopic, adrenalectomy, experienceAbstract
Background: Laparoscopy has become the gold standard for the treatment of adrenal tumors in urology. We evaluate our experience with laparoscopic adrenalectomy (LA) in this work.The aims of this paper were to review our experience with laparoscopic transperitoneal adrenalectomy, report on outcomes, and demonstrate any learning curve with the technique.
Methods: A review of our database and patient records was carried out total of 65 laparoscopic adrenalectomyfor the period January 2001 to December 2010. Patient demographics, tumor characteristics, operating times, outcomes and lengths of stay were studied. Diagnostic tools, including tumour size on pathological section were reviewed.
Results: Indications for surgery included patients with primary hyperaldosteronism (39 adenomas, 3 hyperplasias), 10 phaeochromo-cytomas, 8 cortisol-secreting adenomas, 1 adrenal cyst, 1 metastasis, 1 lymphoma, 1 myelolipoma and 1 ganglioneuroma. The tumors ranged in size from 10 to 85 mm. All tumors were localized and lateralized preoperatively using standard techniques. Throughout the review period, twenty-three open procedures were undertaken electively, for various reasons. 9 cases were converted to open procedures (13.8%).Fourty-six left and 19 right procedures were undertaken. For all laparoscopic procedures, the average time in the operating theatre was 188.2 min. Men took 193.5 min compared with 187.3 min for women. Left-sided lesions took 183.0 min compared with 200.8 min for right-sided lesions. The average length of stay was 11.9 days. There was one splenic and pancreatic injury.
Conclusion: The results achieved in our initial experience with this technique are comparable with the published literature. The results confirm that laparoscopic adrenalectomy is the method of choice for resection of benign adrenal pathology. The procedure has a learning curve and should be performed by a surgeon experienced in both open and laparoscopic adrenal surgery.
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