Laparoscopic Adrenalectomy A comparison with open adrenalectomy

ABSTRACT

BACKGROUNDS The advent of laparoscopic abdominal surgery made it possible to perform a laparoscopic adrenalectomy (LA). We have successfully performed 10 such operations since November 21, 1995. We retrospectively compared the effectiveness and the safety of a laparoscopic adrenalectomy with the effectiveness and the safety of an open adrenalectomy (OA). METHODS: The 45 patients with adrenal diseases who underwent an adrenalectomy from March 1990 to January 1998 were included in this study. Ten (10) laparoscopic cases comprised the study group, and 17 of the 32 open adrenalectomy cases, performed by anterior approach, comprised the control group. RESULTS: No one died from an adrenalectomy. Nine cases (45%) from the OA group needed transfusions (average661 ml), but one patient from the LA group, who had required a conversion to a celiotomy, required a transfusion (400 ml). The operating times were, on average, 191 minutes in the OA group and 230 minutes in the LA group (p = 0.0384). The average size of the masses was 6.5 cm. The first days of walking after the operation was 3.4 days for the OA group and 1.3 days for the LA group (p = 0.0002). The patients' former regular diets were started on days 6.9 and 3.2 for the OA and LA groups, respectively (p = 0.0001). Postoperative in-hospital days were 17.5 for the OA group and 7.9 for the LA group (p = 0.0001). CONCLUSIONS: In comparison with an open adrenalectomy, a laparoscopic adrenalectomy showed better convalescent featuresthat is, less chance of transfusion, earlier recovery, faster resumption of the former diet, shorter postoperative hospital stays, and cosmesis. We think and suggest that a laparoscopic adrenalectomy is a safe and effective procedure, and hopefully it will become the standard choice of operation for various adrenal diseases.