Current Indications And Contraindications Of Laparoscopic Adrenalectomy

Laparoscopic adrenalectomy has become the gold standard approach for the treatment of select patients with aldosteroma, pheochromocytoma, Cushing's disease, nonfunc-tioning adenoma, and rarely, adrenal cyst or myelolipoma. Laparoscopic radical adrenalectomy for primary or metastatic malignancy, has been reported (4).

Unacceptable cardiopulmonary risk, uncorrected coagulopathy, abdominal sepsis, and bowel obstruction represent general contraindications for laparoscopy. Laparoscopic adrenalectomy is currently contraindicated for the treatment of a large adrenocortical carcinoma with local periadrenal invasion or venous thrombus. Morbid obesity is no longer a contraindication to laparoscopic adrenalectomy (7,8).

The first thoracoscopic transdiaphragmatic incisional biopsy of the left adrenal gland was performed by Mack et al. in 1992.

Based on the encouraging results of the porcine study, Gill et al. developed and refined the technique for thoracoscopic nephrectomy and extrapolated the approach to adrenal surgery in human cadavers.

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