Experience with laparoscopic adrenalectomy in children.

In a review of 109 cases reported in the literature, including our own experience with two successful right laparoscopic adrenalectomies performed in a 3-year old girl for androgen-secreting adenoma and in a 9-year-old male for pheochromocytoma, we analysed the indications, surgical techniques and results of video-assisted (laparoscopic or retroperitoneoscopic) adrenalectomy in children. The indications are no different from those for traditional surgery. It seems that there are no age or tumour size limits for a well-trained surgical team. The best endoscopic approach needs to be more clearly defined. Experience shows that laparoscopy is undoubtly preferred for right adrenalectomy (95.2% of cases), while left adrenalectomy has been performed by retroperitoneoscopy in 30% of cases. Considering the conversion rate of laparoscopy vs retroperitoneoscopy (12.5% vs 28.5%), right laparoscopic vs right retroperitoneoscopic adrenalectomy (4.7% vs 100%) and left laparoscopic vs left retroperitoneoscopic adrenalectomy (5% vs 16.6%) and on the basis of our experience in adults, we recommend laparoscopic adrenalectomy via a transperitoneal route in 45-degree flank decubitus for both right and left adrenal lesions. However, we think that the best surgical result can be achieved if the paediatric and adult surgeon collaborate with their different experience and expertise. As a technical point, we would like to stress that because of the child's small peritoneal cavity, trocar placement must be lower than in adults. Lastly, we suggest the use of new technological devices such as the Ultracision Harmonic Scalpel, which was a critical factor in our two successful right laparoscopic adrenalectomies.