Laparoscopic vs Open Adrenalectomy for the Treatment of Primary Hyperaldosteronism

Abstract

Hypothesis: That the clinical presentations, biochemical profiles, and surgical outcomes of patients treated with laparoscopic vs open adrenalectomy for primary hyperaldosteronism are different. Design, Settings, Patients, and Interventions: The medical records of 80 patients with primary hyperaldosteronism who underwent open adrenalectomy between 1975 and 1986 or laparoscopic adrenalectomy between 1993 and 1998 at the University of California-San Francisco were reviewed by a single unblinded researcher (W.T.S.). Main Outcome Measures: Severity of hypertension and hypokalemia at diagnosis, their improvement after adrenalectomy, and operative complications. Results: Thirty-eight patients underwent open adrenalectomy and 42 patients underwent laparoscopic adrenalectomy. The patients who underwent open adrenalectomy had documented hypertension for a median of 5 years before surgery; all had diastolic blood pressures greater than 100 mm Hg. Laparoscopically treated patients had documented hypertension for a median of 2.5 years preoperatively, and 20 (48%) had diastolic blood pressures greater than 100 mm Hg. The median preoperative serum potassium levels for the open and laparoscopic groups were 2.6 mmol/L and 3.3 mmol/L, respectively; the mean serum al

Laparoscopic adrenalectomy

“…Hypokalaemia was uniformly cured by surgery, but persistent hypertension still occurred in the absence of hormonal recurrence 37,61,93 . The reported rates of postoperative hypertension (12-34 per cent) are similar to those of open surgery 93,95 .…”

From incidentaloma to adrenocortical carcinoma: The surgical management of adrenal tumors

“…Laparoscopic adrenalectomy is the operation of choice for resection of aldosteronomas [17]. Blood pressure is normalized or improved in approximately 75% of patients, and hypokalemia resolves in more than 95% of patients [1].…”

Robot-assisted adrenalectomy: current perspectives

“…[1][2][3][4] As compared to open adrenalectomy (OA), LA involves lesser blood loss, lesser pain and shorter hospital stay and offers better cosmesis. [5][6][7][8][9][10][11][12] Despite all these advantages, LA has been restricted to a handful of experienced surgeons at high-volume centers because of certain technical drawbacks like two-dimensional view, stiff non-articulating instruments, dependence on an assistant for camera, etc. Robot-assisted adrenalectomy (RA) is the recent addition to the armamentarium of surgeons.…”