Laparoscopic Adrenalectomy is Superior to an Open Approach to Treat Primary Hyperaldosteronism

Abstract

We reviewed our institutional experience with primary hyperaldosteronism to compare clinical outcomes after laparoscopic versus open adrenalectomy. All patients surgically treated for primary hyperaldosteronism from 1988 through 1999 are included in this study. Patients were assigned to either the LA (laparoscopic) or OA (open) group depending on the initial surgical approach selected for treatment. Records were reviewed to determine demographics, operative results, and complications. Twenty-four patients were surgically treated for primary hyperaldosteronism. There were no significant differences between groups with respect to age, weight, number of preoperative antihypertensive medications, or preoperative potassium level. The results of adrenalectomy with respect to number of postoperative antihypertensive medications or serum potassium level were also similar. Operative times were not significantly different (191 ± 53 minutes for OA and 205 ± 88 minutes for LA) between groups, but four LA patients were converted to OA. Estimated blood loss was 401 ± 513 cm3 for OA and 127 ± 131 cm3 for LA ( P = 0.07). Hospital length of stay was 6.7 ± 3.7 days for OA and 3.3 ± 2.7 days for LA ( P = 0.02). Complications were nine for OA and three for LA ( P = 0.001 by Pearson's Chi square). LA is similar to OA in the treatment of primary hyperaldosteronism. The significantly fewer complications and shorter length of hospital stay associated with LA makes the laparoscopic approach the preferred method for treating primary hyperaldosteronism.

Laparoscopic adrenalectomy for management of a functional adrenal tumor in a cat

“…[8][9][12][13][14] Compared with traditional open adrenalectomy for management of PHA in humans, LA is associated with decreased postoperative morbidity, signs of pain, duration of hospitalization, and recovery time. [17][18][19] This has resulted in the adoption of LA as the standard of care for human patients with unilateral PHA. 18 It cannot be proven at this time that the advantages of a minimally invasive approach seen in humans would be realized in cats, although studies [20][21][22] in dogs have shown decreases in signs of pain and a more rapid return to normal activity after minimally invasive surgery, compared with open surgery.…”

Bilateral Adrenalectomy for Ectopic Cushing’s Syndrome—Discussions on Technique and Indication

“…Moreover, the technique for adrenalectomy has developed over the last decade, and laparoscopic adrenalectomy has become the gold standard for unilateral adrenalectomy, at least for tumors measuring less than 6 cm. [7][8][9] Laparoscopy is also increasingly proposed for removal of bilateral adrenal tumors.…”

“…Because of the severity and rarity of the disease, there are few reported series documenting treatment outcomes,4–6 and there have been no randomized trials. Moreover, the technique for adrenalectomy has developed over the last decade, and laparoscopic adrenalectomy has become the gold standard for unilateral adrenalectomy, at least for tumors measuring less than 6 cm 7–9. Laparoscopy is also increasingly proposed for removal of bilateral adrenal tumors.…”

Laparoscopic Approach Reduces Likelihood of Perioperative Complications in Patients Undergoing Adrenalectomy

“…12 Retrospective studies have shown that patients undergoing LA have less postoperative pain, shorter postoperative hospital stay, faster return to normal activities, and fewer procedure-related complications compared to patients undergoing open adrenalectomy (OA). [13][14][15][16][17][18][19] In particular, the reduction of adrenalectomy-related complications compared to those seen historically with OA has made the laparoscopic approach to be held responsible for the positive impact on adrenal surgery during the past decade.F" Consequently, it is considered the treatment of choice for small, benign adrenal tumors. However, most reported comparative series include the surgeons' learning curve of this procedure, during which relatively easier cases are expected to be performed.…”