Laparoscopic Adrenalectomy: A Step-by-Step Guide

Edgar J. Figueredo, MD; Oscar M. Crespin, MD; Peter C. Wu, MD; Roger P. Tatum, MD; Brant K. Oelschlager, MD; Carlos A. Pellegrini, MD

Disclosures

July 11, 2013

Minimally Invasive Adrenalectomy

Laparoscopic adrenalectomy (LA) was first reported in 1992.[1] Since then, it has become increasingly used, and as a result of overall cost-effectiveness compared with the open approach, it is now the technique of choice for most benign adrenal lesions. A review of the National VA Surgical Risk Study database revealed that patients who underwent open adrenalectomy (n = 311) compared with LA (n = 358) were more likely to be older, have a higher American Society of Anesthesiologists classification, and harbor malignancy. Even after adjustment for confounders, open adrenalectomy was associated with increased operative time, transfusion requirement, hospital length of stay, and 30-day morbidity.[2]

Candidates for Adrenalectomy

The following brief case descriptions exemplify patients who are candidates for adrenalectomy.

Case 1. A 64-year-old woman presented with a right adrenal mass that was detected incidentally on ultrasonography and posteriorly confirmed by CT. The mass measured 3 × 4 cm and was a well-shaped, homogenous, low-density (27 Hounsfield units) tumor.

The patient was asymptomatic. She had a medical history of breast cancer and had undergone a mastectomy as part of her treatment. Extensive work-up ruled out a functioning adrenal tumor, and a biopsy confirmed a metastasis from the breast. A decision was made to perform LA.

Case 2. A 54-year-old woman who presented with vague abdominal pain, nausea, and general fatigue was found incidentally to have a left adrenal mass on CT scan of the abdomen. The CT showed a homogenous enhanced lesion in the left suprarenal gland, measuring 6.5 × 6.0 × 4.5 cm. Extensive work-up ruled out a functioning adrenal tumor, but because of the size of the mass, a decision was to perform LA.

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