Laparoscopic adrenalectomy: preoperative data, surgical technique and clinical outcomes

Backgroundlaparoscopic adrenalectomy has become the standard treatment for adrenal lesions. The better clinical outcoms of laparoscopic technique are valid for treatment of small benign masses (<5-6cm), instead there are still open questions in literature regarding the correct management of larger lesions (>6cm) or in case of potentially malignant adrenal tumors. The aim of this study is to evaluate the outcomes of laparoscopic adrenalectomy in a referral surgical department for endocrine surgery.Methodsat the University Hospital Policlinico P. Giaccone of Palermo between January 2010 and December 2017 we performed a total of 81 laparoscopic adrenalectomy. We created a retrospective database with analysis of patients data, morphologic and hormonal characteristics of adrenal lesions, surgical procedures and postoperative results with histological diagnosis and complications.ResultsMean size of adrenal neoplasm was 7,5cm (range 1.5 to 18cm). The mean operative time was 145min (range 75-240). In statistical analysis lenght of surgery was correlated to the lesion diameter (p<0.05) but not with pre-operative features or histological results. 5 intraoperative complications occurred. Among these patients 4 presented bleeding and 1 a diaphagmatic lesion. No conversion to open surgery was necessary and no intraoperative blood transfusion were required. Mean estimated blood loss was 95ml (range 50-350). There was no capsular disruption during adrenal dissection. Mean length of hospital stay was 3.7days (range 3-6days).ConclusionsLaparoscopic adrenalectomy is a safe procedure with low rate of morbidity. An accurate preoperative radiological examination is fundamental to obtain a stringent patients selection. The lesion diameter is related to longer operative time and appeares as the main predictive parameter of intraoperative complications but these results are not statistically significant. On the other side secreting adrenal tumors require more attention in operative management without increased rate of postoperative complications.