Conclusions

After a decade of worldwide experience, laparoscopic adrenalectomy has successfully passed its "definition" phase and achieved maturation. Based on our experience, and that of others, laparoscopic adrenalectomy is a well-established technique and is currently the treatment of choice for benign functioning and nonfunctioning neoplasms of the adrenal gland. Although other laparoscopic approaches are feasible, they have their limitations and offer no clear advantage over the lateral transabdominal approach, the preferred technique practiced by most surgeons performing laparoscopic adrenalectomy. The limited experience with the procedure in malignancy shows some promise, but its role is yet to be clarified. Currently, invasive adrenocortical carcinoma and metastatic pheochromocytoma to periaortic nodes are the only absolute contraindications. Only experienced laparoscopic surgeons should attempt laparoscopic resection of large masses and, generally, the minimally invasive technique is not advisable for lesions greater than 12 to 14 cm.

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chapter 75

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