A comparison of open and laparoscopic approaches to adrenalectomy in patients with phaeochromocytoma.

We compared the perioperative profiles of patients undergoing unilateral phaeochromocytoma resection performed by open adrenalectomy with those performed by laparoscopic adrenalectomy. Data was collected prospectively on 24 patients (12 open, 12 laparoscopic). All patients underwent extensive preoperative medical preparation with phenoxybenzamine and beta-blockers. The final preoperative dose of phenoxybenzamine was similar in each group (laparoscopic 119+/-60 mg/day, open 100+/-25 mg/day). Intraoperative haemodynamic instability was assessed by the requirement for therapeutic intervention. More haemodynamic instability was observed in the laparoscopic group but the differences were not statistically significant. Sodium nitroprusside use to treat hypertension (systolic blood pressure >180 mmHg) was more frequent and the duration of the infusions longer in the laparoscopic group; high dose beta-blocker therapy with atenolol and/or esmolol to treat intraoperative tachycardia (heart rate >90) was also more frequent in the laparoscopic group. The small sample size of the study limited the ability to detect a true difference. Blood loss was greater in the open adrenalectomy group but the difference was not significant. The operating time was significantly longer (236+/-78 vs 147+/-47 min, P<0.01) but the duration of postoperative hospitalization was significantly shorter (5+/-2 vs 11+/-4 days, P<0.01) in the laparoscopic group. Postoperative complications were not significantly different. There were no perioperative deaths. Overall, we observed more haemodynamic instability in patients undergoing laparoscopic resection but were unable to demonstrate a statistically significant difference. In our experience, laparoscopic adrenalectomy has the advantage of a shorter time to discharge from hospital.