Use of laparoscopic techniques improves outcome from adrenalectomy

Background Laparoscopic adrenalectomy is a promising alternative to open approaches but safety and efficacy remain unproven. Methods A recent experience with laparoscopic adrenalectomy at the University of Washington was analyzed for efficacy, complications, evolution of technical steps, and clinical outcome. Results Ninteen adrenalectomies were performed in 16 patients with a mean age of 52 years. Indications included pheochromocytoma (4), functional adenoma (12), and uncontrolled Cushingʹs disease (3). All patients had computed tomography scans. Meta-iodo-benzyl-guanidine (MIBG) or iodocholesterol scans were done in selected patients. Three patients had bilateral procedures, 7 were on the left and 6 on the right, all via a transperitoneal flank approach. There were no conversions and all procedures were successful. Complications included subcapsular liver hematomas (2), one transfusion, and a bleeding port site requiring repeat laparoscopy. Except for 1 patient with COPD, the mean length of stay was 2.9 days. Conclusions Laparoscopic adrenalectomy in appropriate patients is safe and effective. For endocrine surgeons with advanced laparoscopic skills, it should be considered a new standard therapy for benign adrenal tumors.