Over 10 Years of Experience in the Laparoscopic Treatment of Adrenal Lesions via Lateral Transperitoneal Approach

Abstract

LA have been performed in 405 patients. The indications were 195 (48%) non-functioning incidentaloma type tumors and 210 (52%) functioning tumors. Among them hypercortisolism in 66 (31.5%) patients (Cushing's disease -3, Cushing's syndrome -28, subclinical Cushing's syndrome -35), pheochromocytoma in 82 (39%), Conn's syndrome in 61 (29%) and adrenogenital syndrome in 1 (0.5%). There where 288 (71%) women and 117 (29%) men with the mean age of 51.8 years. The mean size of adrenal tumor was 41.1 mm. In 62 (15%) bilateral lesions were noted. All patients were operated laparoscopically via lateral transabdominal approach. Results. LA was successful in 393 patients (97%). We performed 393 (97%) unilateral LA, 10 (2.5%) bilateral simultaneous LA, 2 (0.5%) bilateral two-staged LA and also 2 (0.5%) sparing LA. 12 (3%) patients underwent simultaneous LA with laparoscopic cholecystectomy due to symptomatic cholecystolithiasis and 2 (0,5%) with laparoscopic umbilical hernioplasty. 12 (3%) conversions were necessary. 15 (3.7%) complications occurred, 3 (0.7%) intraoperative and 12 (3%) postoperative. There was 1 remote death on the 56th postoperative day. Conclusions. 1. LA should be recognize as the referential method in the treatment of adrenal pathology. 2. Results, as well as avoiding unnecessary complications and intraoperative difficulties is possible thanks to: close cooperation with the endocrinologist, experience gained from performing other laparoscopic operations, experience got at making open adrenalectomies. Key words: adrenal tumors, adrenalectomy, laparoscopy, minimally invasive surgery Making by Claymana in the year of 1991 laparoscopic kidney operation started a new era of interest in using this method outside the peritoneal cavity (1, 2).It confirmed the possibility of applying insuflation of peritoneum for safe preparing the retroperitoneal organs. Snow demonstrated it, making in the same year first laparoscopic adrenalectomy (LA). In the next year, in 1992 many multicenters reported of using the laparoscopic method in adrenal glands surgery. Confirming its safety and the benefit caused the rapid development of this new operating technique. In consequence creating video-laparoscopic accesses to the adrenal, comparable to existing in the classical surgery. It was a desire to apply techniques the least invasive (3-8).The approval of the medical fraternity allowed the widening of indications, additional the development and creation of new technologies and the equipment reduced limitations of this method.Therefore the purpose of this work was to present own, over 10 years experience of using the laparoscopy in adrenal surgery via lateral transabdominal approach.