Retroperitoneal Laparoscopic Adrenalectomy for Functioning Adrenal Tumors

Abstract

Retroperitoneal laparoscopic adrenalectomy is feasible for primary aldosteronism. However, Cushing's syndrome is presently a much more difficult indication than primary aldosteronism for this new operative technique.

Complications of Laparoscopic Adrenalectomy in 75 Patients Treated by the Same Surgeon

“…This complication rate is also similar to that already reported for laparoscopic adrenalectomy [6, 7, 8, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22]and for other laparoscopic surgeries with complex procedures such as laparoscopic radical nephrectomy (34%) [23]and laparoscopic pyloromyotomy (21.2%) [25]. Although the complication rate was higher than that of gynecological laparoscopy (1–4%) [23]or laparoscopic cholecystectomy (9.6%) [27], the rate was lower in the latest 35 patients undergoing laparoscopic or retroperitoneoscopic adrenalectomy (17.1%).…”

“…In this series, 5 of 75 patients (6.7%) were converted to open surgery including 1 emergency and 4 elective conversions. The conversion rate is similar to that of other reported series, such as about 5% (0–17%) for laparoscopic adrenalectomy [6, 7, 8, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22], 3% for laparoscopic simple nephrectomy [23], 16% for laparoscopic radical nephrectomy [23], 7% for laparoscopic colectomy [24], 12.2% (3% emergency and 9.1% at subsequent surgery) for laparoscopic pyloromyotomy [25], and 4% for laparoscopic hysterectomy [26]. …”

“…However, 3 cases of shoulder pain and 2 of postoperative mild paralytic ileus, probably due to pneumoperitoneum and manipulation of the intestine, occurred after laparoscopic adrenalectomy, and no such complications occurred with retroperitoneoscopic adrenalectomy. There have been several reports describing the efficacy of extraperitoneal retroperitoneoscopic adrenalectomy for small adrenal tumors [13, 14, 15]. Bonjer et al [15]performed a case control study of 9 open, 9 transperitoneal laparoscopic, and 12 retroperitoneal endoscopic adrenalectomies, and they concluded that retroperitoneal endoscopic adrenalectomy was optimum in patients with small adrenal tumors.…”