[Laparoscopic surgery in the treatment of adrenal pathology: experience with 200 cases].

OBJECTIVE We report our experience in laparoscopic adrenalectomy, after adopting the laparoscopic technique for 10 years as a primary option for suprarenal surgery. METHODS We included 200 laparoscopic adrenal surgeries performed consecutively in 183 patients with surgical adrenal pathology between November 1994 and November 2005. Sixty-seven (36.6%) patients were male and 116 (63.4%) were female, with an average age of 49.1 years (age range 8 months to 78 years). RESULTS The most frequents clinical diagnosis were hyperaldosteronism (17.5%), metastatic cancer (15.8%), pheochromocytoma (15.3%), Cushing syndrome (7.1%), adrenal cyst (4.9%) and myelolipoma (2.7%). A total of 164 total adrenalectomies, 29 partial adrenalectomies and 7 marsupializations of adrenal cysts were performed. Mean surgical time was 82.6 minutes (range 25 to 240 minutes) and mean hospitalization time was 2.5 days (range 1-10 days). The size of the suprarenal gland and/or tumor varied between 1 and 14 cm (average 5.6 cm). The rate of complication was 6%. In 8 of the patients, there was another laparoscopic procedure besides the adrenal surgery: cholecystectomies (2), marsupialization of a renal cyst (2), block nephrectomy (2), partial nephrectomy for a tumor (1) and pancreatic cystectomy (1). One patient underwent a right laparoscopic adrenalectomy and an ipsilateral percutaneous nephrolithotomy. CONCLUSION The accumulated experience with 200 laparoscopic adrenal procedures has allowed the management of endocrine pathologies, such as, aldosteroma, pheochromocytoma, Cushing syndrome and rare entities, such as, cysts, myelolipomas in a suitable manner. Additionally, it has permitted us to extend the benefits of a minimally invasive procedure for large adrenal masses and selected oncology cases.