Purpose: Laparoscopic adrenalectomy (LA) has become the procedure of choice to treat functioning and non-functioning adrenal tumours. With improving experience, large adrenal tumours (> 5 cm) are being successfully tackled by laparoscopy.
Material and methods: Thirty-five laparoscopic adrenalectomies performed in 32 patients for adrenal lesions during the period from 2006 to 2012 were analyzed.
Results: Mean tumour size was 5,03 cm (range, 2-11 cm). Tumour size was larger than 8 cm in four patients. The lesions were localized on the right side in 17 patients and on the left one in 15 patients while bilateral tumours were established in three patients. Functioning tumours were present in 22 out of 32 patients. Average blood loss was 112 mL (range, 20-400 mL) with the mean operating time being 144 min (range, 45-270 min). Three patients underwent conversion to open procedure. Final histology revealed malignant tumours in three of 32 patients (9,52%).
Conclusion: LA is safe and feasible for large adrenal lesions. Mere size should not be considered as a contraindication to laparoscopic approach in large adrenal masses. Graded approach, perfect preoperative assessment and planning, team work and adherence to anatomical and surgical principles are the key to success.
Assalia, A., M. Gagner. Laparoscopic
adrenalectomy.- Br. J. Surg., 91, 2004, No 10,
-1274.
Brunt, L. M., G. M. Doherty, J. A. Norton, N. J.
Soper, M. A. Quasebarth, J. F. Moley. Laparoscopic
adrenalectomy compared to open adrenalectomy
for benign adrenal neoplasms.- J. Am. Coll. Surg.,
, 2004, No 1, 1-10.
Dalvi, A. N., P. M. Thapar, K. Vijay Kumar, R.
S. Kamble, S. A. Rege, A. A. Deshpande, et al.
Laparoscopic adrenalectomy: Gaining experience
by graded approach.- J. Minim. Access Surg., 2,
, No 2, 59-66.
Erbil, Y., U. Barbaros, G. Karaman, A. Bozbora,
S. OzarmaÄŸan. The change in the principle of
performing laparoscopic adrenalectomy from small
to large masses.- Int. J. Surg., 7, 2009, No 3, 266-271.
Gagner, M., A. Lacroix, E. Bolte. Laparoscopic
adrenalectomy in Cushing`s syndrome and
pheochromocytoma.- New Engl. J. Med., 327, 1992,
No 14, p. 1033.
Gagner, M., A. Pomp, B. T. Heniford, D. Pharand,
A. Lacroix. Laparoscopic adrenalectomy: lessons
learned from 100 consecutive procedures.- Ann.
Surg., 226, 1997, No 3, 238-246; discussion, 246-247.
Hemal, A. K., A. Singh, N. P. Gupta. Whether
adrenal mass more than 5 cm can pose problem in
laparoscopic adrenalectomy? An evaluation of 22
patients.- World J. Urol., 26, 2008, No 5, 505-508.
Jacobs, J. K., R. E. Goldstein, R. J. Geer.
Laparoscopic adrenalectomy. A new standard
of care.- Ann. Surg., 225, 2004, No 5, 495-501;
discussion 501-502.
Karanikola, E., C. Tsigris, K. Kontzoglou, N.
Nikiteas. Laparoscopic adrenalectomy: where do
we stand now?- Tohoku J. Exp. Med., 220, 2010,
No 4, 259-265.
Kebebew, E., A. E. Siperstein, Q. Y. Duh.
Laparoscopic adrenalectomy: the optimal surgical
approach.- J. Laparoendosc. Adv. Surg. Tech. A, 11,
, No 6, 409-413.
Kebebew, E., Q. Y. Duh. Adrenal incidentaloma.-
In: Current surgical therapy. J. L. Cameron, ed.
Philadelphia, Elsevier Mosby, 2004, 575-579.
Novitsky, Y. W., D. R. Czerniach, K. W. Kercher,
R. A. Perugini, J. J. Kelly, D. E. Litwin. Feasibility
of laparoscopic adrenalectomy for large adrenal
masses.- Surg. Laparosc. Endosc. Percutan. Tech.,
, 2003, No 2, 106-110.
Palazzo, F. F., F. Sebag, M. Sierra, G. Ippolito,
P. Souteyrand, J. F. Henry. Long-term outcome
following laparoscopic adrenalectomy for large
solid adrenal cortex tumors.- World J. Surg., 30,
, No 5, 893-898.
Papalia, R., G. Simone, C. Leonardo, A. Loreto,
R. Coppola, S. Guaglianone, et al. Laparoscopic
transperitoneal right adrenalectomy for `large`
tumors.- Urol. Int., 81, 2008, No 4, 437-440.
Porpiglia, F., P. Destefanis, C. Fiori, G. Giraudo,
C. Garrone, R. M. Scarpa, et al. Does adrenal size
really affect safety and effectiveness of laparoscopic
adrenalectomy?- Urology, 60, 2002, No 5, 801-805.
Prinz, R. A. A comparison of laparoscopic and
open adrenalectomies.- Arch. Surg., 130, 1995,
No 5, 489-492, discussion 492-494.
Ramacciato, G., P. Mercantini, M. La Torre, F.
Di Benedetto, G. Ercolani, M. Ravaioli, et al. Is
laparoscopic adrenalectomy safe and effective for
adrenal masses larger than 7 cm?- Surg. Endosc., 22,
, No 2, 516-521.
RamÃrez-Plaza, C. P., A. RodrÃguez-Cañete, M. E.
DomÃnguez-López, M. Valle-Carbajo, C. Jiménez-
Mazure, N. MarÃn-Camero, et al. Development
and evolution of laparoscopic adrenalectomy in
an specialized team: from the beginning to the
outpatient setting.- Endocrinol. Nutr., 57, 2010,
No 1, 22-27 (in Spanish).
Rosoff, J. S., J. D. Raman, J. J. Del Pizzo.
Laparoscopic adrenalectomy for large adrenal
masses.- Curr. Urol. Rep., 9, 2008, No 1, 73-79.
Sharma, R., A. Ganpule, M. Veeramani, R. B.
Sabnis, M. Desai. Laparoscopic management of
adrenal lesions larger than 5 cm in diameter.- Urol.
J., 6, 2009, No 4, 254-259.
Shen, W. T., E. Kebebew, O. H. Clark, Q. Y. Duh.
Reasons for conversion from laparoscopic to open
or hand-assisted adrenalectomy: review of 261
laparoscopic adrenalectomies from 1993 to 2003.-
World J. Surg., 28, 2004, No 11, 1176-1179.
Shen, T. W., C. Sturgeon, Q. Y. Duh. From
incidentaloma to adrenocortical carcinoma: the
surgical management of adrenal tumors.- J. Surg.
Oncol., 89, 2005, No 3, 186-192.
Sturgeon, C., E. Kebebew. Laparoscopic
adrenalectomy for malignancy.- Surg. Clin. North
Am., 84, 2004, No 3, 755-774.
Thornton, J. K. Abdominal nephrectomy for large
sarcoma of the left suprarenal capsule: recovery.-
Trans. Clin. Soc. Lond., 23, 1890, 150-153.
Zografos, G. N., G. Vasiliadis, A. N. Farfaras, C.
Aggeli, M. Digalakis. Laparoscopic surgery for
malignant adrenal tumors.- J. Soc. Laparoendosc.
Surg., 13, 2009, No 2, 196-202.
Zografos, G. N., A. Farfaras, G. Vasiliadis, T.
Pappa, C. Aggeli, E. Vasilatou et al. Laparoscopic
resection of large adrenal tumors.- J. Soc.
Laparoendosc. Surg., 14, 2010, No 3, 364-368.
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