Laparoscopic adrenalectomy (LA): keys to success: correct surgical indications, adequate preoperative preparation, surgical team experience.

BACKGROUND: Laparoscopic adrenalectomy (LA) has become the surgical procedure of choice for the treatment of most adrenal lesions. Controversy still remains about the treatment for primary and secondary malignant lesions and for pheochromocytoma.
MATERIALS AND METHODS: From September 1997 to December 2005, 77 patients were operated on for adrenal tumors in a single center. Three patients had bilateral lesion for a total of 80 adrenalectomies. Selection criteria for laparoscopic treatment included benign characteristics of the lesions regardless of size and absence of virilization syndrome. A multidisciplinary approach was used for adequate preparation of patients with functional lesions. Fifty-five patients were eligible for LA and 22 for open surgery.
RESULTS: Mean operative time was 142 minutes (range 45 to 240) in the laparoscopic group (53 patients) and 161 minutes (range 90 to 300) for the open group (24 patients). In 2 patients (4%) conversion to open procedure was necessary for intraoperative bleeding. Laparoscopic surgery in patients with pheochromocytoma was associated with a better intraoperative hemodynamic stability.
CONCLUSIONS: LA is the treatment of choice for benign adrenal tumors regardless of size. Appropriate selection of patients, adequate preoperative preparation of patients with functional lesions and expertise in adrenal surgery and advanced laparoscopic skills are necessary to allow reduction of perioperative morbidity and early recovery.