Page 26 - Laparoscopic Surgery Online Journal

10.5005/jp-journals-10033-1200
Bandar N Alharthi et al
ORIGINAL ARTICLE
Retrospective Review of Laparoscopic Adrenalectomy:
An Experience at King Fahad Medical City, Riyadh

Bandar N Alharthi, Syed Zahid Zadie, Javeria Iqbal

ABSTRACT The present study was undertaken with the objective of

Background: Laparoscopic adrenalectomy is considered the assessing the effectiveness of laparoscopic adrenalectomy
standard surgical approach for adrenal tumors and is replacing in terms of operative time, complications and length of
the open technique in the majority of centers. The aim of the
hospital stay.
present study was to review the authors experience with
laparoscopic adrenalectomy.
MATERIALS AND METHODS
Materials and methods: A retrospective review of laparoscopic
adrenalectomies performed by an endocrine surgeon over a The present study was conducted at King Fahad Medical
period of 4 years at King Fahad Medical City was conducted City, Riyadh over a period of 4 years from June 2008 till
perioperative and postoperative records were studied.
June 2012. .
Results: Total of 10 patients underwent laparoscopic A retrospective review was made and included 10 patients
adrenalectomy. Mean operative time was 3 hours and
30 minutes; length of hospital stay was significantly low. who underwent complete transperitoneal laparoscopic
Complications were few, with one patient developing a unilateral adrenalectomy. A formal approval was taken from
port site hernia.
the Ethical Review Board.
Conclusion: Laparoscopic adrenalectomy can be performed The following data was analyzed: age and gender; tumor
safely and has the advantages of minimally invasive surgery. characteristics like site, size, functional status, operative time
With experience the technical aspects show marked
improvement as there is a learning curve. and blood loss, complications, pathology and length of
hospital stay.
Keywords: Adrenal tumors, Adrenalectomy, Laparoscopy.
How to cite this article: Alharthi BN, Zadie SZ, Iqbal J. Operative Technique
Retrospective Review of Laparoscopic Adrenalectomy: An
Experience at King Fahad Medical City, Riyadh. World J Lap The laparoscopic adrenalectomy was performed by trans-
Surg 2013;6(3):138-140.
peritoneal approach. The patient is placed on the operative
Source of support: Nil table in the lateral decubitus position with the table extended
to facilitate exposure. In our study access to the peritoneal
Conflict of interest: None declared
cavity was obtained by the open technique in the first three
INTRODUCTION cases and by the closed technique using Veress needle in
the rest of the cases. The abdomen is insufflated with carbon
Adrenal tumors represent a wide spectrum of pathologies
ranging from benign adenoma to adrenocortical carcinoma. dioxide to a pressure of 15 mm Hg. A 10 to 12 mm trocar is
Indications for adrenalectomy include hormone secretion placed into the abdominal cavity and the laparoscopic
and/or perceived risk of malignancy (i.e. tumor size, camera inserted. The underlying viscus is examined for any
evidence of injury. Three additional 10 to 12 mm trocars
radiographic features, local invasion, lymph node involvement
or distant metastasis). 1-3 are placed, one each in the midclavicular line approximately
The introduction of laparoscopic cholecystectomy in two finger breaths below the costal margin, in the anterior
4
1988 ushered in a new surgical era. The potential benefits axillary line at a similar level to the camera port, and in the
of minimally invasive operations include shorter hospital posterior axillary line. This posterior-most port has to be
stay, minimal morbidity, rapid postoperative recovery and inserted after the hepatic or splenic flexure has been reflected
an early return to preoperative activities. 5 from the abdominal wall. The approach to the right adrenal
The surgical approach to the adrenal gland requires a gland is performed by completely dividing the triangular
large flank incision leading to increased morbidity. Adrenal ligament of the right lobe of the liver up to the suprahepatic
surgery was revolutionized by the introduction of laparoscopy. 6 vena cava. The peritoneum is further separated inferiorly
The adrenal glands are ideal for a laparoscopic approach and the liver retracted to facilitate the exposure of the inferior
as they are small and have a low incidence of malignancy. 7-9 vena cava. The adrenal gland dissection begins from the
Laparoscopic adrenalectomy has become the standard medial margin and gradually proceeds toward the lateral
technique for the surgical removal of the adrenal glands at margin. The adrenal vein entering the vena cava is identified
many centers worldwide. 10 early in the course of dissection and is doubly ligated with
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