Ján Ľupták, Michael Vraný, Ján Švihra, Ján Kliment
Objective: Laparoscopic adrenalectomy has become standard treatment for adrenal diseases in the last ten years. The aim of this study was retrospective analysis of our 5-year experience with laparoscopic adrenalectomy.
Material and metdhods: From March 2001 to December 2005, we performed 33 laparoscopic adrenalectomies (16 right, 17 left) for adrenal tumours by a transperitoneal approach in 31 patients (16 men, 15 women) with mean age of 47,5 years (range 36 to 73). Bilateral adrenalectomy were performed simultaneously in two (6,4 %) patients (one patient after failed transsphenoidal operation of hypophysis for central Cushing syndrome, one patient suffered from CT suspected bilateral adrenal gland metastasis). Concomitant hypertension occured in 12 (38,7 %) patients and 14 (45,2 %) had previous abdominal cavity operation.
Results: The laparoscopic procedure was succesfully completed in 28 (90,3 %) from 31 patients. The average adrenal tumor size was 4,1 cm (range 1,1 - 8,7). All procedures required 4 trocars and a mean operative time of 138 min (47 - 280 min.), while in the second half of the patient the operating time decreased about one third. Blood transfusions were performed in three (9,7 %) cases. One patient (3,2 %) with heamorrhage due to vena cava vein injury and one (3,2 %) with bleeding from adrenalectomy bed underwent conversion to an open surgery. Third patient with bleeding from adrenalectomy bed was treated via laparoscopic approach. Histological evaluation of the extracted adrenal glands revealed following: 14 (42,5 %) nodular hyperplasia, 7 (21,2 %) pheochromocytomas, 7 (21,2 %) adenomas, 3 (9,1 %) myolipomas, l (3 %) ganglioneuroma and l (3 %) metastasis of renal cell cancer.
Conclusions: Laparoscopic adrenalectomy is safe and effective surgical modality which has become the surgical procedure of first choice for adrenal removal. Laparoscopic approach appears to be a minimally invasive and safe therapeutic option for adrenal tumours. This technique has low morbidity, low postoperative analgesic requirements and shorter hospital stay.