Laparoscopic adrenalectomy for large tumors

Aim of the study.- To analyze indications and results of laparoscopic adrenalectomy for large tumors (>6cm). Methods. - It is a retrospective study including patients between January 1994 and December 2003 operated on for large adrenal lesions greater than or equal to6 cm. The size was given by the pathologist. All the patients had a flank transperitoneal approach. Analysed Parameters were: operative difficulties; operative time; conversion rate; postoperative morbidity, follow-up and histologic data. Results. - Fourteen patients (10 female and 4 male) were included. Mean age at the time of the diagnosis was 52 years (range: 17-79). Mean size of the lesions was 7 cm (range: 6-10 cm). Mean operative time was 132 mn (range: 120-240 mn). None of the patients experienced surgical complications. Two conversions were needed (for vena cava attachments in one case and because of a retrocava localization in the other case). Three patients had morbidity: one intraperitoneal hemorrage occuring at the second postoperative day and needing laparotomy; one lelft pneumopathy; and one case of nevralgy due to a port insertion. Mean hospital stay was 4,5 days. Histologic data showed: five ganglioneuromas, three pheochromocytomas, three adenomas, two adrenocortical carcinomas, and one postpancreatitis cytosteatonecrosis. Conclusion. - Laparoscopic adrenalectomy is feasible for large lesions greater than or equal to6 cm when no evidence of malignity is demonstrated neither by the preoperative imaging study nor by the surgical exploration. (C) 2004 Publie par Elsevier SAS.