Laparoscopic approach to the adrenal tumors.

Over the years, a number of different surgical approaches to the adrenal glands have been devised. The anterior transabdominal approach is considered to be a source of postoperative morbidity. However, this conviction can be changed. The laparoscopic approach was used in four patients. One had a right 5 cm nonfunctioning tumor, the second had a 1.8 cm right aldosterone-producing adenoma, the third patient had a 4 cm adrenocortical adenoma, and the fourth patient had a bilateral pheochromocytoma (tumor size was 3.5 cm and 4.5 cm in the right and left adrenals, respectively). Carbon dioxide pneumoperitoneum was used in three patients, but helium pneumoperitoneum was used in the patient with bilateral pheochromocytoma to prevent CO2 retention. Single right adrenalectomy lasted between 2 h and 2 h 30 min, and bilateral adrenalectomy lasted 5 h 30 min. The hospital stay was between 3 and 4 days. Unilateral or bilateral adrenalectomy through laparoscopy can be performed safely and has the advantage of avoiding the muscular trauma related to laparotomy or rib resection necessary for the extraperitoneal approach.