Complications of Laparoscopic Adrenalectomy: Results of 169 Consecutive Procedures

Abstract

Laparoscopic adrenalectomy (LA) has become the gold standard for adrenalectomy. Review of the literature indicates that the rate of intra- and postoperative complications is not negligible. The aim of this study was to evaluate the complications observed in a series of 169 consecutive LAs performed at a same center for a variety of endocrine disorders. Between June 1994 and December 1998 a series of 169 LAs were performed in 159 patients: 149 unilateral LAs and 10 bilateral LAs. There were 98 women and 61 men with a mean age of 49. 7 years (range 22-76 years). There were patients with 61 Conn syndrome, 41 with Cushing syndrome, 1 androgen-producing tumor, 29 pheochromocytomas, and 37 nonfunctioning tumors. Mean tumor size was 32 mm (range 7-110 mm). LA was performed by a transperitoneal flank approach in the lateral decubitus position. Mean operating time was 129 minutes (range 48-300 minutes) for unilateral LA and 228 minutes (range 175-275 minutes) for bilateral LA. There was no mortality. Twelve patients had a significant complication (7.5%): three peritoneal hematomas requiring (in two cases) laparotomy and (in one case) transfusion; one parietal hematoma; three intraoperative bleeding episodes without need for transfusion; one partial infarction of the spleen; one pneumothorax; one capsular effraction of the tumor; and two deep venous thromboses. Eight tumors were malignant at final histology (4.7%), of which four were completely removed laparoscopically. Conversion to open surgery was required in eight cases (5%): for malignancy in four cases, difficulty of dissection in three cases, and pneumothorax in one case. With a mean follow-up of 26.58 months (range 6-60 months) all patients are disease-free. We conclude that LA is a safe procedure. With increasing experience the morbidity becomes minor. To avoid complications LA should be converted to open surgery if local invasion is suspected or if there is difficulty with the dissection.

Laparoscopic Adrenalectomy: Lessons Learned from 306 Cases

“…Indications for operations in this study were similar to those in published series, in which most of the operations were performed for aldosteronomas, glucocorticoid excess, pheochromocytomas, and incidentalomas 10,11 .…”

Laparoscopic vs. Open Adrenalectomy: Experience at King Faisal Specialist Hospital and Research Centre, Riyadh

“…12 It is the likelihood of malignancy and local invasion associated with large tumor size that make it sometimes difficult to be removed laparoscopically, not the size per se. 13,14 The operative time was reported by some authors to be significantly longer in laparoscopic adrenalectomy, however, this was not the case in our study. 7,16 We found that the optic magnification in laparoscopy and the clarity of anatomy made the dissection and adrenal vessels control much easier and faster.…”

THERAPY IN ENDOCRINE DISEASE: Etomidate in the management of hypercortisolaemia in Cushing's syndrome: a review

“…Laparoscopic adrenalectomy is highly effective in the ectopic ACTH syndrome (2) and occasionally in Cushing's disease, but its use may cause unnecessary or inappropriate delay. Patients should be referred in a timely fashion to a facility where appropriate laparoscopic surgical expertise exists.…”