Laparoscopic adrenalectomy by transabdominal lateral approach. Should we be afraid of getting started? First 5 years of experience

Abstract

Introduction: A laparoscopic approach has become the standard procedure for removing adrenal masses. However, the need for experience with the technique continues to be emphasized. The aim of this study was to retrospectively review the first 5 years of data of patients who had an adrenal mass and underwent laparoscopic surgery with a transabdominal lateral approach. Materials and Methods: All of the patients at a single institution who were operated on for an adrenal mass using a laparoscopic transabdominal lateral approach between January 2014 and January 2019 were included. The demographic data, any history of other abdominal surgery, American Society of Anesthesiologists score, preoperative diagnosis, hormonal characteristics of the tumor, intraoperative parameters, intraand postoperative complications, and the histological diagnosis were analyzed. Results: A total of 42 laparoscopic adrenalectomy procedures were performed. The mean age of the patients was 50.64±13.22 years. The lesion was located on the right side in 52.3% of the patients. Nine patients (21.4%) had previously undergone abdominal surgery for various reasons. The majority of the adrenal masses were a secretory adenoma or hyperplasia of the gland. Four patients were operated on for metastasis of other malignancies and others were non-secreting tumors. The mean size of the adrenal lesions was 29.4±12.7 mm. The mean operative time was 140.45 minutes and the mean blood loss was 62.9 mL. Intraoperative complications occurred in 3 cases (7.1%). Complications were observed postoperatively in 9 patients (21.4%). The mean length of hospitalization was 3.8±2.1 days. Conclusion: A laparoscopic adrenalectomy proved to be a safe and feasible method, even in cases in which it was the operator's first experience with the procedure. The results of a first application were similar to those reported in the literature. However, we strongly believe that other prior laparoscopic experience is required to achieve these results.