Laparoscopic Adrenalectomy

Michel Gagner, MD, FRCSC, FACS ■ Ahmad Assalia, MD

Recent advances in minimally invasive techniques have made it possible to perform complex surgical procedures laparoscopically. The adrenal gland lends itself well to laparoscopic removal because of the small size of the gland, the benign nature of most adrenal tumors, and the difficulty in the access to the glands via the open approach. Since its first description in 1992,1 laparoscopic adrenalectomy has proved to be the procedure of choice for the surgical treatment of benign adrenal disease. Multiple reports have consistently demonstrated the well-known benefits of minimally invasive surgery, including decreased analgesic requirements, less blood loss, and shorter hospital stay and recovery time, over the conventional approach.2 8 These results were not surprising considering that the procedure, similar to laparoscopic cholecystectomy, avoids an upper abdominal incision; does not require any reconstruction; benefits from magnification and clarity of view; is commonly performed for benign disease; and mostly involves small, easily extractable specimens. Proper application of minimally invasive surgery to the adrenal gland must take into account expertise in both endocrine and laparoscopic surgery. For successful adrenalectomy, one must have knowledge of the anatomy and disease process, maintain meticulous hemostasis, and delicately handle tissue.

With conventional adrenalectomy, the surgical approach varied according to size, location, possibility of multiple tumors, patient habitus, and tumor invasiveness. These conventional approaches include the posterior, flank, thoracoabdominal, and transabdominal approaches. All these open procedures invariably require large incisions and rib resections with the posterior approaches, resulting in significant postoperative morbidity (including chronic pain syndromes because of injury to intercostal and other nerves).9 Although these conventional approaches will undoubtedly still be required for certain adrenal pathologies, laparoscopic adrenalectomy, eliminating many of the problems of open surgery, has become the gold standard for resection of most adrenal diseases.

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