A comparison of laparoscopic and open adrenalectomies
R. A. Prinz
Department of General Surgery, Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill, USA.
OBJECTIVE: To compare the relative merits of conventional transabdominal
and posterior methods with a laparoscopic approach for adrenalectomy.
DESIGN: A retrospective cohort study of consecutive series of patients
having unilateral adrenalectomy for lesions less than 10 cm in diameter.
SETTING: University hospital. PATIENTS: Ten patients who underwent
laparoscopic adrenalectomy: 11, transabdominal adrenalectomy; and 13,
posterior adrenalectomy. MAIN OUTCOME MEASURES: Operative time, estimated
blood loss, length of hospital stay, and postoperative parenteral analgesic
need. RESULTS: There was no significant difference in the operative time
for laparoscopic and anterior adrenalectomy (mean +/- SD, 212 +/- 77
minutes vs 174 +/- 41 minutes), but the time for posterior adrenalectomy
was significantly shorter (139 +/- 36 minutes) (P < .01). The mean (+/-
SD) hospital stay after laparoscopic removal (2.1 +/- 0.9 days) was
significantly shorter than the stay after anterior (6.4 +/- 1.5 days) and
posterior (5.5 +/- 2.9 days) adrenalectomy. The postoperative need for
parenteral pain medication as measured by the number of doses and the total
milligrams of meperidine hydrochloride administered was significantly less
with laparoscopic adrenalectomy compared with either open procedure (P <
.0001). CONCLUSIONS: Laparoscopic adrenalectomy may take longer to perform
than conventional open approaches but it has clear-cut advantages in
shortening postoperative hospital stay and lessening postoperative
analgesic requirements. It may be the preferred method for most patients
requiring adrenalectomy.
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Zeh and Udelsman
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Kebebew et al.
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MacGillivray et al.
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Editorial: Evolving Surgical Management for Patients with Pheochromocytoma
Duh
J. Clin. Endocrinol. Metab. 2001;86:1477-1479.
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Laparoscopic Adrenalectomy for Adrenocorticotropin-Dependent Cushing's Syndrome
Vella et al.
J. Clin. Endocrinol. Metab. 2001;86:1596-1599.
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The Surgical Approach to the Adrenal Gland: a Comparison of the Retroperitoneal and the Transabdominal Routes in 326 Operations on 284 Patients
Nagesser et al.
Jpn J Clin Oncol 2000;30:68-74.
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Laparoscopic Adrenalectomy
Barresi and Prinz
Arch Surg 1999;134:212-217.
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The Role of Laparoscopic Surgery in Adrenal Disease
Wells
J. Clin. Endocrinol. Metab. 1998;83:3041-3043.
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Lacroix
J. Clin. Endocrinol. Metab. 1998;83:3043-3046.
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Norton
J. Clin. Endocrinol. Metab. 1998;83:3048-3049.
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