Muljibhai Patel Urological Hospital
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Adrenalectomy

Adrenalectomy

Overview

Adrenal lesions can be functional or non functional. Non-functional adrenal tumors frequently present as an incidental finding on CT or MR imaging. The indication for their removal lies in the size of adrenal mass; whether large (>5cm) at diagnosis, or enlarging on serial examination. The small size of the adrenal gland, the benign nature of most adrenal tumors and the difficulty of gaining access to the organ by open surgical means make the laparoscopic approach particularly suitable for adrenalectomy.

Ever since, Gagner reported first Laparoscopic Adrenalectomy in 1992, it has become a new gold standard for removing benign adrenal gland and has replaced open surgical procedures. Many reports have confirmed the advantages of Laparoscopic Adrenalectomy over open adrenalectomy. Laparoscopy offers a shorter hospital stay, decrease in postoperative pain, early return to activity and improved cosmesis.

We have done laparoscopic adrenalectomy in 32 cases; age range varies from 8 – 60 years. Average operative time was 137 minutes (60-240 min.), blood loss 1.26 g% (0.2– 4.0g %), hospital stay 6.7 days (3-16 days).

The procedure was uneventful in all cases. Indications include pheochromocytoma, functioning adenoma, nonfunctioning cortical adenoma, Pseudo cyst, Myelolipoma and one case of adrenocortical carcinoma and metastases in 2 cases. Approach used in our patients was lateral transperitoneal in 30, and retroperitoneal in 2 cases. A variety of laparoscopic approaches to the adrenal gland exist. In all cases of pheochromocytoma, transperitoneal approach was safe and there was no hemodyanmic instability.

How it is done?

Adrenal vein could be controlled early in the procedure and blood pressure dropped to normal in the post-op period. This exposure assists the surgeon to ligate the adrenal vasculature with minimal manipulation and retraction of the adrenal gland. Moreover, access to adjacent organs is also easier with the transperitoneal approach and inadvertent injury of neighboring viscera during dissection is also more easily avoided in this approach.

Transperitoneal laparoscopic adrenalectomy is safe in both adult and pediatric patients, has minimal morbidity with short hospital stay. But with experience and expertise large and non-invasive adrenal carcinoma can also be dealt safely, with laparoscopy.

We have published our experience in Urology Journal, “Laparoscopic management of adrenal lesions larger than 5 cm in diameter” Urol J. 2009 Fall;6(4):254-9 which can be accessed with the following link:

http://www.urologyjournal.org/index.php/uj/article/view/500/401