Surgical options in adrenalectomy: laparoscopic versus open surgery.

Small hormone-active benign tumors are considered as clear indication for laparoscopic adrenalectomy. Laparoscopy resection of pheochromocytomas is still a controversial issue, but recent data have shown that the specific risks of pheochromocytoma surgery are not increased by the laparascopic approach. The majority of endoscopic adrenalectomies are performed via the transperitoneal route, but there is growing interest in the retroperitoneoscopic approach. The advantages and disadvantages of each endoscopic approach have to be weighed carefully, but the final decision will also depend on the experience of the surgeon. Several retrospective studies have compared laparoscopy with open surgery. There is general agreement that laparoscopy is superior to open surgery since it is associated with less pain, a shorter hospital stay, and more rapid return to normal activities, and also yields the best cosmetic and long-term results. Partial adrenalectomy may be indicated for bilateral pheochromocytoma, and also has advantages for patients with aldosterone-producing adenomas. The feasibility of laparoscopic partial adrenalectomy has been demonstrated. Laparoscopic intraoperative ultrasonography is valuable in selected cases. The already low morbidity of laparoscopic adrenalectomy can be reduced further by using needlescopic techniques.