Page 26 - World Journal of Laparoscopic Surgery

RESEARCH ARTICLE
Factors Predicting Success of Laparoscopic Adrenalectomy:

Our Experience

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Varun Agarwal , Amit Sharma , Mukund Andankar , Hemant Pathak 4
AbstrAct
Introduction: Adrenal is one of the most feared organs owing to its anatomical position. However, adrenalectomy by laparoscopic means has
now been adopted as the procedure of choice to treat benign and malignant functioning and nonfunctioning adrenal tumors. We describe our
experience with laparoscopic adrenalectomy (LA) in 37 patients at a tertiary institute and try to predict factors for open conversion.
Materials and methods: Thirty-seven patients who underwent LA from August 2013 to February 2018 were retrospectively analyzed and factors
leading to conversion to open adrenalectomy assessed.
Results: Among 37 patients, 31 had pheochromocytoma on histopathology and 1 patient had adrenal hyperplasia leading to Cushing’s
syndrome. Five out of 37 patients had to be converted to open technique—multiple adhesions with the bowel, retrocaval tumor extensions,
difficult dissection, and prolonged operative time due to large tumor size (in two patients) and severe hepatomegaly were the reasons for
conversion to open.
Conclusion: Laparoscopic adrenalectomy is safe and feasible for large adrenal lesions.
Keywords: Adrenalectomy, Laparoscopic, Success.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1422

IntroductIon 1,3,4 Department of Urology, Topiwala National Medical College and

Adrenalectomy is often performed by surgeons with an interest BYL Nair Hospital, Mumbai, Maharashtra, India
or training in endocrine surgery. Adrenal is one of the most feared 2 Department of Urology, All India Institute of Medical Sciences, Raipur,
organs because of its deep retroperitoneal location and close Chhattisgarh, India
relation to vital structures. Adrenalectomy by laparoscopic means Corresponding Author: Amit Sharma, Department of Urology, All
is one of the successful applications of minimally invasive surgical India Institute of Medical Sciences, Raipur, Chhattisgarh, India, Phone:
techniques. It has now been adopted as the procedure of choice +91 8691898668, e-mail: dramiturology@gmail.com
to treat benign and malignant functioning and nonfunctioning How to cite this article: Agarwal V, Sharma A, Andankar M, et al. Factors
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adrenal tumors. Adrenalectomy was initially done by open surgery Predicting Success of Laparoscopic Adrenalectomy: Our Experience.
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when Sargent performed the first planned adrenalectomy in 1914. World J Lap Surg 2020;13(3):125–127.
However, laparoscopic adrenalectomy (LA) is now being done also Source of support: Nil

for hypervascular tumors and large benign and malignant adrenal Conflict of interest: None
tumors. 3
We report our experience in 37 patients who underwent LA cava (IVC) on the right side, the renal vein on the left side, and the
and the factors which affected their conversion to open in 5 cases. presence or absence of lymph nodes.
The success of laparoscopic surgery was defined as completion
MAterIAls And Methods of the entire surgery by laparoscopic means. If, at any point during

Thirty-seven patients who underwent LA from August 2013 to the surgery, there occurred a difficulty or a complication that was
February 2018 were retrospectively analyzed based on age, sex, and not manageable laparoscopically, the patient was converted to
detailed history which would suggest a syndromic association or open surgery.
past history of abdominal surgery. The weight and height of patients Patients with suspicion of malignancy, tumor invasion
were taken to calculate the body mass index (BMI). of adjacent organs, and patients who were high risk due to
The department of endocrinology at our institute primarily cardiopulmonary disease were excluded from the study.
evaluated these patients. Depending on the suspected pathology, All specimens, after extraction, were sent for a histopathology
an appropriate hormonal workup was done and patients with examination.
functional as well as nonfunctional tumors were referred to us
for surgical management. The ones with functional tumors like Technique
pheochromocytoma and Cushing’s syndrome were stabilized All patients were operated on under general anesthesia and a
preoperatively. lateral transabdominal flank approach was used with an intra-
All patients underwent contrast-enhanced computerized abdominal pressure of 12 mm Hg. Wherever necessary hemostasis
tomography (CECT) and/or magnetic resonance imaging (MRI) was achieved using bipolar coagulation, Harmonic scalpel, Ligaclips,
for delineating the size of the gland, relation with inferior vena Hem-o-lok clips.

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