Is size really a contraindication for laparoscopic resection of giant adrenal myelolipomas?

A 55-year-old non-diabetic, normotensive man presented with dull aching pain in the left upper abdomen of 2-year duration. He had no significant medical, surgical or family history. Relevant blood tests and chest skiagram were normal. 24 h urinary vanillylmandelic acid levels and serum electrolyte levels were normal. Ultrasonogram and CT findings were suggestive of a 15 × 11 cm giant left adrenal myelolipoma. A left adrenalectomy was performed using a laparoscopic transperitoneal approach employing three ports. Pneumoperitoneum was achieved by this closed method. After successful excision, the internal contents were suctioned and the capsule was retrieved through a 2.5 cm incision. The operating time was 210 min and total blood loss 50-60 mL; no blood transfusions were needed. The patient was discharged on the third postoperative day. Histopathology confirmed an adrenal myelolipoma. The cited case is of the largest adrenal myelolipoma resected entirely using a laparoscopic approach. 2016 BMJ Publishing Group Ltd.