Laparoscopic Adrenalectomy: History, Indications, and Current Techniques for a Minimally Invasive Approach to Adrenal Pathology

Abstract

Refinements in the field of laparoscopic general surgery have not only made the performance of laparoscopic adrenalectomy technically feasible, but have even made it the preferred method of treatment for benign adrenal pathology. The advantage of the laparoscopic approach lies in the fact that it allows precise, hemostatic dissection of the gland in a minimally invasive fashion. We present here the results of published reports of laparoscopic adrenalectomy as well as our own experience, and compare these data with reports from open procedures. The indications for the surgical removal of the adrenal gland have not changed, and include: endocrine active tumors, suspected malignancies, adrenal masses larger than 6 cm, and masses that have been followed and observed to be growing. Laparoscopic adrenalectomy can be accomplished with one of three approaches: anterior, lateral and posterior. Each approach has advantages and limitations, and our preferences are discussed. The general techniques are briefly described. The findings from many studies show that the blood loss, operative complications, hospital stay and recovery period are significantly reduced with the laparoscopic approach. Based on our experience with 19 laparoscopic adrenalectomies and a review of the current literature, laparoscopic adrenalectomy can be fairly described as the current "gold standard" treatment for benign adrenal disease. Patients benefit from short hospital stays, lower morbidity, and a more rapid recovery. The only question that remains is the appropriateness of laparoscopic adrenalectomy in the treatment of adrenal malignancy, and the answer to this will depend on the results of long-term outcome studies.

Adrenalectomy may increase survival of patients with adrenal metastases

“…However, adrenalectomy is a large and traumatic operation that requires careful selection of patients (6), and the results remain controversial (3)(4)(5). Laparoscopic adrenalectomy has become the 'gold standard' of treatment for benign adrenal masses (7,8). However, this remains a controversial approach for known malignant diseases (2,9,10).…”

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

“…[8][9][10][11] The choice of surgical approach depends mainly on the surgeons' experience and orientation, as well as the tumor pathology, size, function, and the patient's clinical history. Initially, we started laparoscopic adrenalectomy for nonfunctioning small tumors, and later on, laparoscopic adrenalectomy became our procedure of choice for all adrenal tumors, unless there was proven or highly suspicious malignancy.…”

Anesthesia for laparoscopic adrenalectomy (pheochromocytoma) in an anemic adult Jehovah’s Witness

“…The blood loss during a laparoscopic technique is less than that of open resection of adrenal tumours. [5][6][7][8] The surgical team was experienced in the technique and it had been FIGURE 3 Serum catecholamine levels measured intraoperatively, before induction of anesthesia ("pre-ind"), following completion of surgery ("end"), and at times of increased heart rate and blood pressure, occurring concurrent with tumour manipulation. the consistent experience that blood loss was small and less than that seen with open resection.…”

“…As well as reducing blood loss, laparoscopic adrenalectomy is associated with shorter hospital stays and shorter recovery time compared with open techniques. [5][6][7][8] The hemodynamic and catecholamine responses to laparoscopic adrenalectomy have been well described. 9 The times of peak hemodynamic response and catecholamine secretion are during the creation of the pneumoperitoneum and during tumour manipulation.…”