Indications For Laparoscopic Adrenalectomy

The indications for laparoscopic adrenalectomy have expanded as more surgeons have become proficient with the technique and the advantages of this approach have become apparent. In many centers, laparoscopic adrenalectomy has become the surgical procedure of choice for the management of functional tumors less than 6 cm in size. Although the presence of pheochromocytoma was a relative contraindication for laparoscopic adrenalectomy in the past, it is clear that the procedure can be performed safely as long as the same precautions are taken as those for open surgery (14). The current indications for performing a laparoscopic adrenalectomy are listed in Table 2.

There are few contraindications to laparoscopic adrenalectomy. Absolute contraindications to laparoscopic adrenalectomy include uncorrectable coagulopathy and severe cardiopulmonary disease precluding general anesthesia. Patients who may not tolerate an open operation are generally poor candidates for laparoscopic adrenalectomy.

Relative contraindications to laparoscopic adrenalectomy include previous abdominal surgery or significant morbidity. Lesions greater than 8 cm in size, even if not suspected to be primary adrenal carcinomas, should be approached cautiously because of the increased risk of hemorrhage and injury to surrounding viscera.

With increasing experience in performing laparoscopic adrenalectomy, relative contraindications become less of a factor. In addition, a variety of approaches to laparoscopic adrenalectomy, including transperitoneal and retroperitoneal, have further decreased some of the relative contraindications. It is generally felt that a known or suspected primary adrenal carcinoma, particularly with extension into surrounding organs, should be removed by an open technique. Given the aggressive nature of the disease, the open approach allows for en bloc resection and potential removal of surrounding organs (8).

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