Publication

Abstract : Introduction: Laparoscopic Adrenalectomy (LA) is the accepted gold standard procedure for the removal of adrenal masses of all pathologies. Materials and Methods: We retrospectively analysed all laparoscopic adrenalectomies performed at our institution from July 2002 . August 2007. The cases were studied with respect to indications, peroperative techniques and events, complications, histopathology and postoperative outcomes. Results: 75 LA.s were done in 61 patients- 23 were left sided and 24 right sided while 14 were bilateral. The patients included 40 females and 21 males with a mean age of 39.9 (1 - 72) years. The three most common indications were pheochromocytoma (25), incidentalomas (14) and Cushing's disease (11). Majority were operated by a lateral trans-abdominal approach using 3 ports. The mean size of the masses was 5.6 (1.7-14) cms, of which 26 were larger than 6 cms. The mean operating time including unilateral and bilateral procedures was 132 (50-270) minutes. The mean blood loss was 66.8 (20-300) ml. All were completed laparoscopically though 3 required a terminal hand assist. 18 patients had significant hemodynamic alterations during various stages of surgery that were managed accordingly. Postoperative analgesia was achieved routinely with diclofenac supplemented by opiates as necessary. Mean hospital stay was 4 (2-9) days. Three patients developed perioperative complications requiring prolonged intensive care. Two other patients had immediate postoperative complications such as adrenal crisis and chyluria. The most common histologic diagnosis was phaeochromocytoma in 25 cases. Conclusion: LA can be performed for all adrenal pathologies with considerably short operating time and minimum blood loss thereby reducing complications, postoperative pain and hospital stay. Large lesions may also be attempted with increasing experience and terminal hand assistance is a good alternative. Bilateral single stage LA significantly reduces morbidity especially in Cushingoid patients.