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WJOLS
REVIEW ARTICLE Laparoscopic Adrenalectomy: Surgical Technique

Laparoscopic Adrenalectomy: Surgical Technique

Thawatchai Tullavardhana
Department of Surgery, Faculty of Medicine, Srinakarinwirot University, Thailand

Abstract
Laparoscopic adrenalectomy was first described in 1992 by Gagner et al. In present, this minimally invasive procedure are become “gold
standard” surgical management of small and medium sized benign adrenal tumor. This review article aims to describe various type of
surgical technique to perform laparoscopic adrenalectomy including new minimally invasive technique as single access laparoscopic
adrenalectomy, role of natural orifice transluminal endoscopic surgery (NOTES) in adrenalectomy to complete gland dissection, method
of patients selection (indication, contraindication) and show benefits of laparoscopic adrenalectomy compare with conventional open
surgery technique.
Keywords: Adrenal gland, laparoscopic surgery, surgical technique, adrenalectomy.

INTRODUCTION • Postoperative recovery
• Benefit outcome compare with open surgery.
Laparoscopic adrenalectomy was first described in 1992
by Gagner et al. In present this minimally invasive procedure MATERIALS AND METHODS
are become “gold standard” surgical management of
Cushing’s syndrome, pheochromocytoma, aldosteronoma, A literature review was performed using Google, MD
and adrenal incidentaloma. Benefit outcome of laparoscopic consult, PubMed. The following search terms were used:
adrenalectomy are less postoperative pain, decrease laparoscopic adrenalectomy, surgical technique, laparos-
postoperative morbidity, decreased hospital stay and allow copic vs open adrenalectomy, complication of laparoscopic
patients to recover faster, more overall patient satisfaction adrenalectomy. Criteria for selection of literature were the
when compared with an open approach. 1 methods of analysis (statistical or non-statistical), operative
procedure (various type of laparoscopic adrenalectomy
AIMS technique) and comparison of various surgical technique
The aim of this study was to describe various type of surgical (operative time, blood loss, complication).
technique to perform laparoscopic adrenalectomy including
new minimally invasive technique as single access Method of Patient Selection
laparoscopic adrenalectomy, role of natural orifice All of patients present with adrenal lesion should be evaluated
transluminal endoscopic surgery (NOTE) in adrenalectomy. for:
The following parameters were evaluated for this 1. Biochemical hormonal activity: The aim of this test is
laparoscopic and procedures. to determine functional activity of adrenal lesion, such
• Method of patient selection as plasma and urine catecholamines for
– Investigation pheochromocytoma and 24 hours urine cortisol for
– Indication for surgery Cushing’s syndrome. That is important in perioperative
– Contraindication for surgery care including blood pressure control, fluid and electrolyte
• Preoperative preparation status and other anesthesia considerations.
• Operative technique 2. Imaging study: CT scan is the preferred radiologic
– Type of anesthesia modality, Finding on CT scan that suggest benign adrenal
– Patient position lesion include homogenous round shape, size–smaller
– Operative approach than 3 cm, smooth, well-circumscribed border and
– Comparison outcome of various surgical technique attenuation coefficients less than 10 Hounsfield’s units.
• Intraoperative and postoperative complications Potential adrenal malignancy lesion are finding on CT
• Postoperative care scan as size larger than 5 cm, presence of central

World Journal of Laparoscopic Surgery, May-August 2010;3(2):91-97 91