Pablo Laje1, Peter A Mattei. 1. Department of Pediatric Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Abstract
PURPOSE: The aims of this study were to present our experience with children who underwent laparoscopic adrenalectomy for adrenal tumors over a 4-year period, discuss the technical aspects of the procedure, and review the current literature. METHODS: We performed a retrospective review of all laparoscopic adrenalectomies performed at our institution between August 2003 and August 2007. RESULTS: Eight patients underwent laparoscopic adrenalectomy. There were 6 girls and 2 boys. The median age was 14.5 years (range, 2-18). The median weight was 53.5 kg (range, 13-73). We performed 6 left and 2 right adrenalectomies. A lateral transperitoneal approach was used in all cases. All left adrenalectomies required three ports, while the right adrenalectomies were completed with four ports. All cases were done with two or three 5-mm ports and one 10-mm port. Tumor size ranged from 3 to 7 cm maximum diameter. The mean operative time was 99 minutes (range, 58-140). There were no complications. Blood loss was minimal in all cases and none required a conversion to open. All patients resumed oral feeds immediately after surgery. The mean hospital stay was 1.5 days (range, 1-2). The need for narcotic analgesia was minimal. Final diagnoses included: adrenal cortical adenoma (n = 4), ganglioneuroma (n = 2), pheochromocytoma (n = 1), and neuroblastoma (n = 1). CONCLUSIONS: Laparoscopic adrenalectomy appears to be a safe, effective technique in children with small, well-circumscribed adrenal masses. The lateral transperitoneal approach offers optimal visualization and excellent outcomes in terms of minimal discomfort, rapid recovery, and excellent cosmesis.
PURPOSE: The aims of this study were to present our experience with children who underwent laparoscopic adrenalectomy for adrenal tumors over a 4-year period, discuss the technical aspects of the procedure, and review the current literature. METHODS: We performed a retrospective review of all laparoscopic adrenalectomies performed at our institution between August 2003 and August 2007. RESULTS: Eight patients underwent laparoscopic adrenalectomy. There were 6 girls and 2 boys. The median age was 14.5 years (range, 2-18). The median weight was 53.5 kg (range, 13-73). We performed 6 left and 2 right adrenalectomies. A lateral transperitoneal approach was used in all cases. All left adrenalectomies required three ports, while the right adrenalectomies were completed with four ports. All cases were done with two or three 5-mm ports and one 10-mm port. Tumor size ranged from 3 to 7 cm maximum diameter. The mean operative time was 99 minutes (range, 58-140). There were no complications. Blood loss was minimal in all cases and none required a conversion to open. All patients resumed oral feeds immediately after surgery. The mean hospital stay was 1.5 days (range, 1-2). The need for narcotic analgesia was minimal. Final diagnoses included: adrenal cortical adenoma (n = 4), ganglioneuroma (n = 2), pheochromocytoma (n = 1), and neuroblastoma (n = 1). CONCLUSIONS: Laparoscopic adrenalectomy appears to be a safe, effective technique in children with small, well-circumscribed adrenal masses. The lateral transperitoneal approach offers optimal visualization and excellent outcomes in terms of minimal discomfort, rapid recovery, and excellent cosmesis.