Page 29 - Journal of Laparoscopic Surgery

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10.5005/jp-journals-10033-1340
A decade of Laparoscopic Adrenalectomy
RESEARCH ARTICLE

A Decade of Laparoscopic Adrenalectomy

in a Regional Center

1 Ekta Paw, Jason Boldery, Venkat Vangaveti
2
3
ABSTRACT Source of support: Nil
Aim: To evaluate the laparoscopic approach to adrenalectomy Conflict of interest: None
throughout a decade in a single area, focussing on complication
rates and the effect of surgeon experience. Given the relative INTRODUCTION
rareness and pathological heterogeneity of adrenal tumors,
there is still some debate as to whether the laparoscopic Adrenal tumors are a rare and distinctly heterogeneous
approach is suitable for all situations. Initially, laparoscopy group of tumors. They can be differentiated by area of
was not recommended for pheochromocytomas, because of origin within the adrenal cortex or medulla; the degree of
the possibility of adrenergic crisis. Subsequent questions were
raised as to its appropriateness for large tumors (>6 cm) and their symptoms or; into benign and malignant. For most
metastatic deposits due to the technical difficulty of dissection. tumors, the laparoscopic approach has been established
1,2
There has also been an increased number of incidental tumors as the mainstay of treatment. Still, there are a number
(‘incidentalomas’) discovered while imaging for other reasons of questions which have arisen in regards to when this
(e.g., on CT or MRI).
approach is appropriate.
Materials and methods: De-identified data was collected of Laparoscopic adrenalectomy has been well established
all laparoscopic adrenalectomies within the last decade via for benign cortical tumors, pheochromocytomas, and
electronic and physical chart review, in addition to review of
pathology reports. metastases. The only limiting factor for laparoscopy in
these pathologies is the size of the lesion, with the limit
Results: Ninety-seven adrenalectomies were performed. The
complication rate was 8%, and 40% of cases were incidentalo- being around 12 cm. There is still ongoing debate about
mas. Tumor pathologies noted were: non-secretory adenomas the use of laparoscopy in adrenal carcinoma, with some
(35%), aldosterone-secreting adenomas (18.6%), adrenal authorities stating that only open technique should be used.
metastases (17.5%), pheochromocytomas (13.4%), simple Some data suggest that patients do better in terms of overall
cysts (4.1%) and other pathologies (11.3%). The most significant and disease-free survival with open adrenalectomy.
3
decrease in operative time was between 2005–2008 and 2009
(p <0.0001). No significant relationship between complications The major risks contributing to the morbidity of the
and size of a tumor, nor pathology of a tumor was found. laparoscopic approach are open conversion, long operative
4
time and increased blood loss. A large tumor size (defined
Conclusion and clinical significance: Laparoscopic adrenal-
ectomy in this center has a complication rate similar to other as > 6 cm) is found in the literature to be feasible and safe,
published rates and appears to be a safe procedure for large but possibly with increased operative time and blood
tumors and various pathologies. There is also a demonstrable loss. The other question for the laparoscopic approach
5-8
effect of surgeon experience on operative time.
is concerning the pathology of the lesion. In the case of
Keywords: Adrenal, Adrenalectomy, Cohort, Endocrine, Lapa- malignant tumors, there has been a question of seeding
roscopic, Retrospective. the tumor or spillage if the tumor capsule is broken. It has
How to cite this article: Paw E, Boldery J, Vangaveti V. A Decade shown to be effective in some studies, but the decision to
of Laparoscopic Adrenalectomy in a Regional Center. World J Lap convert to an open should be made early to avoid these
Surg 2018;11(2):81-84.
consequences. 9,10 There have also been a number of studies
looking into the effectiveness for metastatic deposits of the
adrenal gland. 11,12
1 Surgical Resident, Consultant, Senior Research Officer Even though one of the two cases reported in
3
2
1 Department of Surgery, The Townsville Hospital, Townsville, Gagner’s original 1992 paper describing laparoscopic
Queensland, Australia adrenalectomy was a pheochromocytoma, for some time
2 Department of General Surgery, The Townsville Hospital, it was disputed whether this was a safe approach. 13,14 The
Townsville, Queensland, Australia pneumoperitoneum and possible increased handling of
3 Department of Research, The Townsville Hospital, Townsville, a tumor holds risks of the hypertensive crisis, for which
Queensland, Australia invasive arterial pressure monitoring and treatment such

Corresponding Author: Ekta Paw, Surgical Resident, as nitroprusside may be warranted. Subsequent studies
Department of Surgery, The Townsville Hospital, Townsville, have determined that the laparoscopic approach has
Queensland, Australia, email: ektapaw@gmail.com
equivalent if not better blood pressure stability. 15
World Journal of Laparoscopic Surgery, May-August 2018;11(2):81-84 81