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.
