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PubMed2004

Repeat adrenocortical-sparing adrenalectomy for recurrent hereditary pheochromocytoma.

PURPOSE: Many endocrine surgeons advocate subtotal adrenalectomy for patients with bilateral hereditary pheochromocytoma despite the risk of recurrence. However, as the effectiveness of this procedure for locally recurrent pheochromocytoma is not well known, we investigated two patients who underwent this operation. METHODS: We performed repeat subtotal adrenalectomy for recurrent hereditary pheochromocytoma in two patients who had undergone primary subtotal adrenalectomy. RESULTS: Patient 1 was a 23-year-old woman with multiple endocrine neoplasia type 2A, in whom about 25% of the right adrenal gland was left in situ. Patient 2 was a 22-year-old man with von-Hippel-Lindau syndrome, in whom about 25% of both normal adrenal glands was left in situ. No steroid replacement was required postoperatively, and adrenocorticotropic hormone stimulation revealed sufficient adrenocortical function in both patients. No sign of recurrent pheochromocytoma has been found in 96 months and 11 months of follow-up, respectively. CONCLUSION: Recurrent hereditary benign pheochromocytoma after subtotal adrenalectomy may be treated successfully by repeated subtotal adrenalectomy. However, the risk of recurrence and malignancy must be weighed carefully against the risk of lifelong steroid replacement and potential Addisonian crisis. Thus, repeated subtotal adrenalectomy should be considered for selective patients who want to avoid steroid replacement.

Adrenal Gland Neoplasms↗
PubMed1986

Benzodiazepine receptors in rat brain are altered by adrenalectomy.

The effects of adrenalectomy on benzodiazepine receptors in discrete regions of rat brain were examined using [3H]flunitrazepam as binding ligand. The concentration of benzodiazepine receptors was significantly increased by 25, 50 and 71% in hippocampus, striatum and hypothalamus, respectively, after adrenalectomy. In contrast, adrenalectomy did not affect the concentration of benzodiazepine receptors in cerebral cortex, olfactory bulb and cerebellum. No significant differences in the apparent binding affinity (Kd) values were seen following adrenalectomy in any brain region examined. The adrenalectomy-induced increases in [3H]flunitrazepam binding sites were completely reversed by glucocorticoid replacement with dexamethasone. These results demonstrate that adrenalectomy is capable of selectively modulating benzodiazepine receptors in brain regions presumably involved with glucocorticoid negative feedback. The data further suggest additional mechanisms by which endogenous hypothalamic-pituitary-adrenocortical hormones may affect 'anxiety' levels.

Adrenal Glands↗
PubMed1987

Adrenalectomy fails to block salt gland secretion in Pekin ducks (Anas platyrhynchos) adapted to 0.9% saline drinking water.

Salt-adapted Pekin ducks were observed during a 2-week period following adrenalectomy so as to test the hypothesis that NaCl secretion by the nasal salt glands depends on adrenocortical steroids. Three days after adrenalectomy the total inputs of fluid and Na+ during a 90-min iv infusion of 1000 mOsm/kg NaCl were 77 and 80% respectively, of those in the sham-operated controls; 7 days after adrenalectomy they were 88 and 90%. Two weeks after adrenalectomy, cardiovascular function had deteriorated slightly and the total outputs of fluid and Na+ had fallen to 65 and 64%, respectively, of the control outputs. The onset of cardiovascular deterioration was delayed by feeding the ducks 0.9% NaCl drinking water ad libitum for 1 month before, and 2 weeks after, adrenalectomy. Adaptive hypertrophy of the nasal salt glands was not steroid-dependent since there was no measurable decrease in the weight of the glands during a 2-week period following adrenalectomy.

Adaptation, Physiological↗
PubMed1995

Cell-specific modulation of basal and seizure-induced neurotrophin expression by adrenalectomy.

Reports of glucocorticoid effects on neurotrophin expression suggest that adrenal hormones may contribute to the pattern of changes in the expression of these factors induced by neuronal activity and seizures. To examine this possibility, the present study evaluated the influence of adrenalectomy on basal expression and seizure-induced alterations in levels of nerve growth factor, brain-derived neurotrophic factor, and neurotrophin-3 messenger RNAs in hippocampus, entorhinal cortex, and superficial neocortex. For determination of hormone effects on basal expression, adult male rats were adrenalectomized and killed 10-14 days later with paired adrenal-intact controls. For studies of adrenal steroid involvement in expression following seizure, adrenalectomized and adrenal-intact rats received a seizure-producing lesion of the dentate gyrus hilus. Changes in neurotrophin messenger RNA content were assessed by quantitative in situ hybridization. Adrenalectomy alone had no significant effect on brain-derived neurotrophic factor messenger RNA content but did result in cell-specific decreases in nerve growth factor and neurotrophin-3 messenger RNAs. Nerve growth factor messenger RNA levels were reduced in hippocampal stratum granulosum, entorhinal cortex, and neocortex but not in cells of the hippocampal molecular layers or hilus. With adrenalectomy, neurotrophin-3 messenger RNA was virtually eliminated from CA2 stratum pyramidale, partially reduced in stratum granulosum, but unaffected in neurons of the hippocampal molecular layers or entorhinal cortex. These effects were partially reversed by corticosterone (2 mg/l) supplement to the drinking saline. In experimental-seizure rats, adrenalectomy did not alter the direction or basic pattern of seizure-induced changes in neurotrophin expression but did change the time courses and magnitudes of these effects. In all areas measured, brain-derived neurotrophic factor messenger RNA content was more greatly and persistently elevated by seizure in adrenalectomized as compared with adrenal-intact rats. In contrast, with adrenalectomy seizures induced smaller increases in nerve growth factor messenger RNA content. Adrenalectomy augmented the decrease in neurotrophin-3 messenger RNA induced by seizure in hippocampus but not in entorhinal cortex. These results demonstrate that adrenal hormones play a major role in the regulation of basal nerve growth factor and neurotrophin-3 messenger RNA expression by specific populations of forebrain neurons. Moreover, the adrenal steroids have opposite effects on activity-dependent changes in brain-derived neurotrophic factor and nerve growth factor messenger RNA levels but are not required for the basic pattern of changes in neurotrophin messenger RNA expression elicited by recurrent seizures.

Adrenalectomy↗
PubMed2004

Laparoscopic adrenalectomy for malignancy.

Laparoscopic adrenalectomy for primary malignancies and tumors metastatic to the adrenal is controversial. Most studies demonstrate that results of laparoscopic adrenalectomy for malignant lesions are similar to those of open adrenalectomy, without its morbidity. The results of laparoscopic adrenalectomy for tumor metastases suggest that it may benefit patients who have a metachronous metastasis from any of a variety of primary tumors. Selective laparoscopic adrenalectomy for potentially malignant tumors requires seeking signs of local invasion, lymphadenopathy, or distant metastasis; there are no other reliable preoperative criteria of malignancy. Diagnostic laparoscopy may be useful, and in some cases, may establish a diagnosis. Laparoscopic adrenalectomy should be cautiously performed, with the goals of achieving complete tumor resection without disruption of the adrenal capsule.

Adrenal Gland Neoplasms↗
PubMed1998

Posterior or laparoscopic approach for adrenalectomy.

BACKGROUND: The pathologies and size of adrenal lesions removed through the open posterior and laparoscopic routes share remarkable similarities. This study aims at comparing the relative merits of these two approaches. METHODS: Patients with adrenal tumors operated on by posterior approach (n = 56) and transabdominal laparoscopic approach (n = 12) between January 1981 and May 1997 were retrospectively reviewed. RESULTS: The two groups were comparable in terms of age, and the position, size, and weight of the tumor. The operative time of posterior adrenalectomy was significantly shorter than that of laparoscopic adrenalectomy (median 120 minutes versus 160 minutes), whereas laparoscopic adrenalectomy was associated with less parenteral analgesic requirement (median 0 mg versus 225 mg), a shorter hospital stay (median 3 days versus 5 days), and a shorter duration off work (median 11 days versus 26 days). The estimated blood loss was also significantly reduced in the laparoscopic group (median 50 mL versus 150 mL). CONCLUSIONS: Laparoscopic adrenalectomy is replacing posterior adrenalectomy to become the procedure of choice for the majority of patients undergoing adrenalectomy.

Adolescent↗
PubMed1997

Complete adaptation to chronic potassium loading after adrenalectomy: possible humoral mechanisms.

This study was designed to evaluate the mechanisms of adaptation to chronic potassium loading after bilateral adrenalectomy. Studies were performed in Sprague-Dawley rats subjected to 3 days of normal diet and 9 days of high KCl diet followed by adrenalectomy or sham operation on the thirteenth day and 9 additional days of potassium loading (groups 1 and 2, respectively). Animals that underwent adrenalectomy and intact animals, both receiving a normal diet, served as the control groups (groups 3 and 4, respectively). Plasma potassium, urinary potassium and sodium excretion rates, plasma aldosterone and insulin, and Na+-K+ ATPase activity in renal cortical and medullary homogenates were measured. Within 5 days of adrenalectomy the urinary potassium excretion rate in potassium-loaded rats that underwent adrenalectomy (group 1) reached the level observed in potassium-loaded intact rats (group 2), but a significant elevation in plasma potassium levels among rats in group 1 was noticed. In both of the potassium-loaded groups plasma insulin levels and renal cortical and medullary Na+-K+ ATPase activity were significantly higher compared with those in respective control groups receiving a normal diet. Acute clearance experiments carried out in adrenalectomized rats infusing the sera of the potassium-adapted rats that underwent adrenalectomy (obtained at the end of the chronic experiment) showed an uprise in urinary potassium excretion. This result was not observed after the infusion of control sera. These findings suggest that full renal adaptation to chronic potassium loading can be achieved in the absence of aldosterone through mechanisms that might be related to elevated plasma insulin levels (extrarenal); also, a humoral factor associated with the renal adaptation cannot be ruled out.

Adaptation, Physiological↗
PubMed1997

The role of intraoperative ultrasonography during laparoscopic adrenalectomy.

BACKGROUND: The role of laparoscopic intraoperative ultrasonography (IOUS) in intraoperative decision making has grown rapidly in recent years. The purpose of this study was to evaluate its usefulness during laparoscopic adrenalectomy. METHODS: Since 1995, laparoscopic ultrasonography has been used to evaluate the adrenal gland and surrounding organs in selective laparoscopic adrenalectomies. IOUS was performed in 19 of 114 laparoscopic adrenalectomies. RESULTS: IOUS effected a change in management in 68% of these patients. IOUS displayed the location of the gland after a failed attempt at open resection; the adrenal vein, expediting control in four operations; no extraadrenal involvement by two large lesions (benign); vascular invasion in one tumor (carcinoma), prompting open resection; periadrenal invasion by one metastatic cancer and lymph node involvement in another; a 7 mm hyperaldosteronoma; no adenoma in two cases; bilateral hyperplasia; and a 14 cm cyst originating from the adrenal gland. IOUS facilitated partial adrenalectomy in two patients and revealed centrally located adenomas in two others requiring total adrenalectomy. CONCLUSIONS: Laparoscopic IOUS during adrenal operation is valuable in selected cases. It is helpful to locate the gland and vein, confirm the presence or absence of abnormality, discern the resectability of large masses, and facilitate a partial adrenalectomy when desirable.

Adrenal Glands↗
PubMed2003

Laparoscopic partial adrenalectomy in patients with aldosterone-producing adenomas: indications, technique, and results.

OBJECTIVES: To report the indications, technique, and results in patients with primary hyperaldosteronism due to aldosterone-producing adrenal adenoma treated by laparoscopic partial adrenalectomy. Laparoscopy has become the technique of choice in adrenal surgery, but adrenalectomy is the standard procedure. Only a few studies have reported on partial adrenalectomy, and the indications and technique have not yet been clearly defined. METHODS: From June 1995 to December 2001, 13 patients presented with hyperaldosteronism and a single adrenal adenoma (Conn's syndrome) and were treated with laparoscopic partial adrenalectomy. The mean age was 60 years, and the average tumor size was 2.1 cm in diameter. A transperitoneal approach was used in all patients, tumors were resected with safety margins by endoshears, and hemostasis was achieved by bipolar coagulation and finally by sealing with fibrin glue. RESULTS: All procedures were finished laparoscopically, and no conversion was necessary. No major intraoperative or postoperative complication was observed. The histologic examination showed adenomas with negative surgical margins in all cases. Postoperative computed tomography revealed a normal blood supply for the remaining adrenal tissue. Blood pressure and aldosterone levels were unremarkable at follow-up, and no local recurrence was observed. CONCLUSIONS: Laparoscopic partial adrenalectomy for aldosterone-producing adenomas is a minimally invasive procedure with a low complication rate. It provides the benefit of retaining functional tissue on the side of the affected adrenal gland. Therefore, we recommend laparoscopic partial adrenalectomy for patients with small, potentially benign, tumors of the adrenal gland, even with a healthy contralateral adrenal gland.

Adrenal Gland Neoplasms↗
PubMed2003

Laparoscopic upper pole partial nephrectomy with concomitant en bloc adrenalectomy.

OBJECTIVES: To report our experience with laparoscopic partial nephrectomy for renal tumor with concomitant adrenalectomy. An upper pole renal tumor may contiguously involve the adrenal gland, requiring concomitant adrenalectomy. Although commonly performed in the setting of laparoscopic radical nephrectomy, concomitant adrenalectomy has not been described during laparoscopic partial nephrectomy. METHODS: Four patients with an upper pole renal tumor and suspected adrenal involvement underwent laparoscopic partial nephrectomy with concomitant ipsilateral adrenalectomy. Preoperative three-dimensional computed tomography revealed the renal tumor to be closely abutting the adrenal gland in 3 patients and a 4-cm adrenal mass in 1 patient. The mean renal tumor size was 3.2 cm (range 1.4 to 6.6). To maintain oncologic principles, our transperitoneal laparoscopic technique excises the adrenal gland en bloc with the renal tumor. As such, adrenalectomy is performed first, followed by partial nephrectomy, incorporating hilar control, tumor excision, and sutured renal reconstruction. RESULTS: All four procedures were performed without open conversion or intraoperative complications. The mean renal warm ischemia time was 36 minutes, estimated blood loss 169 mL, total operating time 3.9 hours, and hospital stay 3.2 days. One patient developed a transient urinary leak postoperatively. Pathologic examination of the renal tumor revealed renal cell carcinoma (n = 1), dystrophic calcification with ectopic bone formation (n = 1), adult mesoblastic nephroma (n = 1), and subcapsular heterotopic adrenal cortex with cyst (n = 1), all with negative surgical margins. Pathologic examination of the adrenal gland revealed adenoma in 1 case and a normal adrenal gland without malignant involvement in 3 cases. All patients were disease free at last follow-up (mean 6.2 months, range 2 to 12). CONCLUSIONS: In patients with an upper pole renal tumor and radiologically suspected adrenal involvement, laparoscopic partial nephrectomy with concomitant adrenalectomy can be performed efficaciously respecting oncologic principles.

Adenoma↗
PubMed2003

Laparoscopic adrenalectomy--indications and technique.

Laparoscopic adrenalectomy has become the procedure of choice for the surgical management of most adrenal tumors, including functional and non-functional lesions. The role of laparoscopic adrenalectomy in the management of malignant adrenal tumors is controversial and most adrenocortical cancers are generally treated by open adrenalectomy. Laparoscopic adrenalectomy can be performed by both the anterior or lateral trans-abdominal approach and by the lateral or posterior retro-peritoneal approach, with each method being suitable for specific indications. Although there are no randomized trials comparing laparoscopic with open adrenalectomy, the laparoscopic approach is associated with shorter hospital stay, reduced pain and improved cosmesis. This review discusses the indications and contraindications, technique and outcomes for laparoscopic adrenalectomy.

Adrenal Gland Neoplasms↗
PubMed2001

Calcium currents in rat dentate granule cells are altered after adrenalectomy.

Adrenal corticosteroid hormones modulate voltage-gated calcium currents in rat CA1 hippocampal neurons. In the present whole-cell recording study we examined whether calcium currents in dentate granule cells are also under control of corticosteroids. In a first series of experiments, in which the calcium chelator BAPTA was added to the recording solution, the amplitude of calcium currents induced by a voltage step to -10 mV was found to be enhanced shortly (1 or 2 days) after adrenalectomy compared to sham operation. No enhancement was seen when adrenalectomized animals received a low dose of corticosterone in the drinking water. By contrast, 3 or 7 days after adrenalectomy calcium current amplitude was decreased. Starting 3 days after adrenalectomy, some of the granule cells underwent apoptosis. This caused a bias in the recorded cell population towards relatively apoptosis-resistant cells, suggesting that restricted calcium influx may be a key feature of cells withstanding the apoptotic route. In accordance, cells from a small percentage ( approximately 20%) of animals that resisted apoptosis after adrenalectomy also displayed small calcium currents. In a second series without BAPTA, thus focusing on the endogenous calcium-buffering capacity, we found that the time constant for the decay of the calcium current was decreased after adrenalectomy, probably due to enhanced calcium-dependent inactivation of the current. The data indicate that cellular calcium current characteristics of dentate granule cells are altered after adrenalectomy and that the alterations may in part determine the vulnerability to undergo apoptosis.

Adrenalectomy↗
PubMed2002

Hand-assisted laparoscopic adrenalectomy: an alternative minimal invasive surgical technique for the adrenal gland.

BACKGROUND: Presently the surgical approach to the adrenal gland is in a state of flux. While the traditional approach to the adrenal gland has been the open transabdominal technique, more recently laparoscopic approaches, particularly via the transabdominal route, have increasingly been utilized. However, laparoscopic intervention for the adrenal gland can be problematic in certain circumstances, particularly for large adrenal masses and in instances of adrenal malignancies. METHODS: In this report we describe the use of hand-assisted laparoscopic adrenalectomy as an alternative minimal invasive surgical approach to the adrenal gland. Hand-assisted laparoscopic adrenalectomy using the HandPort system (Smith & Nephew, Sydney, Australia) was undertaken in three patients requiring adrenalectomy for mass lesions including one patient with Conn's syndrome. RESULTS: In all three cases, surgery proceeded promptly and uneventfully. In the present paper, the details of the technique of hand-assisted adrenalectomy are described. This is the first report in the world literature of this new technique for the adrenal gland. CONCLUSIONS: Hand-assisted laparoscopic adrenalectomy is an easily performed technique, which can be completed within a short operative time span and which has the advantage of providing intraoperative tactile localization for the adrenal gland. It may be particularly applicable for large adrenal tumours, yet only involves the performance of a small abdominal incision. Postoperative recovery is comparable with that reported for the laparoscopic-only technique. Hand-assisted adrenalectomy is a new technique which has great potential and which warrants further evaluation.

Adrenal Cortex Neoplasms↗
PubMed1997

Laparoscopic adrenalectomy: history, indications, and current techniques for a minimally invasive approach to adrenal pathology.

Refinements in the field of laparoscopic general surgery have not only made the performance of laparoscopic adrenalectomy technically feasible, but have even made it the preferred method of treatment for benign adrenal pathology. The advantage of the laparoscopic approach lies in the fact that it allows precise, hemostatic dissection of the gland in a minimally invasive fashion. We present here the results of published reports of laparoscopic adrenalectomy as well as our own experience, and compare these data with reports from open procedures. The indications for the surgical removal of the adrenal gland have not changed, and include: endocrine active tumors, suspected malignancies, adrenal masses larger than 6 cm, and masses that have been followed and observed to be growing. Laparoscopic adrenalectomy can be accomplished with one of three approaches: anterior, lateral and posterior. Each approach has advantages and limitations, and our preferences are discussed. The general techniques are briefly described. The findings from many studies show that the blood loss, operative complications, hospital stay and recovery period are significantly reduced with the laparoscopic approach. Based on our experience with 19 laparoscopic adrenalectomies and a review of the current literature, laparoscopic adrenalectomy can be fairly described as the current "gold standard" treatment for benign adrenal disease. Patients benefit from short hospital stays, lower morbidity, and a more rapid recovery. The only question that remains is the appropriateness of laparoscopic adrenalectomy in the treatment of adrenal malignancy, and the answer to this will depend on the results of long-term outcome studies.

Adrenal Gland Diseases↗
PubMed1999

Subtotal adrenalectomy for phaeochromocytoma in multiple endocrine neoplasia type 2A.

OBJECTIVE: To describe our surgical technique for, and results of, subtotal adrenalectomy for phaeochromocytoma in multiple endocrine neoplasia (MEN) type 2. DESIGN: Retrospective study. SETTING: Teaching hospital, The Netherlands. SUBJECTS: 6 patients (four women and 2 men, mean age 35 years, range 31-46) with MEN type 2 who presented between 1993 and 1996. INTERVENTIONS: Cortical sparing adrenalectomy (n =4) together with contralateral total adrenalectomy in bilateral disease (n = 2). MAIN OUTCOME MEASURES: Morbidity, mortality, adrenal function postoperatively, and recurrence. RESULTS: Cortical sparing adrenalectomy leaving adequate adrenal reserve was possible in all cases. There was no operative morbidity or mortality. Mean follow-up was 40 months (range 1347). One patient developed a recurrent phaeochromocytoma 24 months after subtotal adrenalectomy. CONCLUSIONS: Subtotal adrenalectomy with preservation of adequate adrenal cortical reserve was feasible in all cases. Long term follow-up is necessary to establish its definitive place in the treatment of familial phaeochromocytoma.

Adrenal Cortex↗
PubMed1992

Dietary glucose and fat attenuate effects of adrenalectomy on energy balance in ob/ob mice.

The body energy balance response of ob/ob mice to adrenalectomy is diet dependent. Diets varying in source of carbohydrate (starch, glucose or fructose), fat to starch ratio, or fat to glucose ratio were fed to determine influences on energy balance in female adrenalectomized ob/ob mice. Adrenalectomy lowered food intake in all ob/ob mice to values comparable to those of lean mice independent of diet, but the percentage of dietary energy retained as body energy in adrenalectomized ob/ob mice was lowered to values comparable to those of lean mice only in mice fed starch or fructose, not in mice fed glucose or fat. Consumption of either high glucose or high fat diets blocked about one-half the overall effect of adrenalectomy on energy balance in ob/ob mice. Hyperinsulinemia was associated with the high efficiency of energy retention observed in adrenalectomized ob/ob mice fed glucose, but high efficiency of energy retention occurred in adrenalectomized ob/ob mice fed high fat diets without concomitant hyperinsulinemia. Adrenalectomy-induced changes in brain weight and protein content, body protein content and plasma thyroid hormone concentrations in ob/ob mice were independent of diet consumption. Combined adrenalectomy-ovariectomy diminished, but did not eliminate, the diet-dependent influences on energy balance in ob/ob mice. In conclusion, dietary glucose and dietary fat both attenuate effects of adrenalectomy on energy balance in ob/ob mice by promoting high efficiencies of energy retention.

Administration, Oral↗
PubMed1997

Bilateral adrenalectomy for Cushing's syndrome. Anterior versus posterior surgical approach.

OBJECTIVE: This study evaluates the intraoperative and postoperative complications in patients with Cushing's syndrome who underwent bilateral adrenalectomy comparing the posterior or anterior operative approach. BACKGROUND: The posterior approach for bilateral adrenalectomy has been advocated over the anterior approach because of rapid recovery and decreased morbidity, but the long-term complications associated with each procedure are not well described. METHODS: The intraoperative profiles and morbidity in 48 patients undergoing bilateral adrenalectomy for Cushing's disease through either the anterior or posterior approach from 1985 to the present were reviewed comparing the intraoperative complication and early and late postoperative complication rate and morbidity. RESULTS: Twenty-seven patients underwent an anterior transabdominal procedure, whereas 21 underwent a posterior retroperitoneal procedure via bilateral incisions. Age, weight, and diagnostic categories of Cushing's syndrome were similar between the two groups as well as serum cortisol and 24-hour urinary cortisol levels. Operative time, estimated blood loss, and transfusion requirements were not different between the groups, even though adrenal glands excised through the anterior approach were significantly larger. Acute morbidity was similar between the groups. However, 17 (81%) of 21 patients who underwent posterior bilateral adrenalectomy suffered from chronic back pain, compared with 2 (7%) of 27 via the anterior approach. Five of these patients in the posterior group considered the pain incapacitating, and the mean time to return to work was significantly longer in the posterior group because of back pain. CONCLUSIONS: The anterior approach to bilateral adrenalectomy has comparable intraoperative complications and early morbidity compared to the posterior approach. The posterior approach has a very high incidence of chronic incision-related back pain. The anterior approach is the preferred open surgical technique in most patients undergoing bilateral adrenalectomy for Cushing's syndrome without other contraindications for undergoing laparotomy.

Adrenalectomy↗
PubMed1997

Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures.

UNLABELLED: One hundred consecutive laparoscopic adrenal procedures for a variety of endocrine disorders were reviewed. There was no mortality, morbidity was 12%, and conversions was 3%. During follow-up, none had recurrence of hormonal excess. Laparoscopic adrenalectomy is the procedure of choice for adrenal removal except in carcinoma or masses > 15 cm. OBJECTIVE: The authors evaluate the effectiveness of laparoscopic adrenalectomy for a variety of endocrine disorders. SUMMARY BACKGROUND DATA: Since the first laparoscopic adrenalectomy was performed in 1992, this approach quickly has been adopted, and increasing numbers are being reported. However, the follow-up period has been too short to evaluate the completeness of these operations. METHODS: One hundred consecutive laparoscopic adrenal procedures from January 1992 until November 1996 were reviewed and followed for adequacy of resection. RESULTS: Eighty-eight patients underwent 97 adrenalectomies and biopsies. The mean age was 46 years (range, 17-84 years). Indications were pheochromocytomas (n = 25), aldosterone-producing adenomas (n = 21), nonfunctional adenomas (n = 20), cortisol-producing adenomas (n = 13), Cushing's disease (n = 8), and others (n = 13). Fifty-five patients had previous abdominal surgery. Mean operative time was 123 minutes (range, 80-360 minutes), and estimated blood loss was 70 mL (range, 20-1300 mL). There was no mortality, and morbidity was encountered in 12% of patients, including three patients in whom venous thrombosis developed with two sustaining pulmonary emboli. During pheochromocytoma removal, hypertension occurred in 56% of patients and hypotension in 52%. There were three conversions to open surgery. The average length of stay has decreased from 3 days (range, 2-19 days) in the first 3 years to 2.4 days (range, 1-6 days) over the past 16 months. During follow-up (range, 1-44 months), two patients had renovascular hypertension and none had recurrence of hormonal excess. CONCLUSION: Laparoscopic adrenalectomy is safe, effective, and decreases hospital stay and wound complications. Prior abdominal surgery is not a contraindication. Pheochromocytomas can be resected safely laparoscopically despite blood pressure variations. Venous thrombosis prophylaxis is mandatory. The laparoscopic approach is the procedure of choice for adrenalectomy except in the case of invasive carcinoma or masses > 15 cm.

Adenocarcinoma↗