Laparoscopic Adrenalectomy
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| Port placement for laparoscopic adrenalectomy. Patient
is positioned lying on the right side. |
Laparoscopic (minimally invasive) adrenalectomy has become the preferred procedure for the
management of most adrenal tumors (1).
It can be applied to treat both nonfunctioning and functioning (hormonally active) tumors,
the latter of which include:
- Aldosteronomas
- Pheochromocytomas
- Tumors causing adrenal Cushing’s syndrome (2).
There is no established upper size limit to the types of tumors that can be removed laparoscopically – this
is generally determined by the experience of the surgeon (3).
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| The surgeon's view of the operation is via a lighted
fiberoptic camera placed through one of the ports. |
Patients who have had previous abdominal surgery are still eligible to undergo laparoscopic
adrenalectomy in most cases.
At UCLA, we have successfully removed tumors >7 cm in diameter using the laparoscopic
approach without event.
The operation is performed under a general anesthetic, with the patient positioned lying
on one side. Four 10 mm (3/8 in.) laparoscopic ports are placed just beneath the rib cage
on the same side as the tumor.
A fiberoptic camera is used to guide the operation, which
typically lasts 1.5 to 2.5 hours.
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| Dressings following laparoscopic adrenalectomy. |
Most patients experience little pain and are able to leave the hospital 1-2 days after surgery,
though this varies depending on the type of adrenal tumor being treated.
Full recovery is rapid.
Patients undergoing laparoscopic adrenalectomy experience:
- Reduced pain
- Better cosmetic outcomes
- Faster return to normal physical activity in comparison those undergoing conventional
(open) adrenalectomy (4).
Patients are generally able to return to work 1 week after surgery.
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References
1. Smith CD, Weber CJ, Amerson JR: Laparoscopic adrenalectomy: new gold standard. World
J Surg, 23: 389-396, 1999.
2. Lal G, Duh QY: Laparoscopic adrenalectomy--indications and technique. Surg
Oncol, 12: 105-123, 2003.
3. Shen WT, Sturgeon C, Clark OH, et al.: Should pheochromocytoma size influence
surgical approach? A comparison of 90 malignant and 60 benign pheochromocytomas.
Surgery, 136: 1129-1137, 2004.
4. Toniato A, Bernante P, Rosse GP, et al.: Laparoscopic versus open adrenalectomy:
outcome in 35 consecutive patients. Int J Surg Investig, 1: 503-507, 2000.
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