Our Experience in Laparocopic Approach for Large Adrenal Tumors

Laparoscopic adrenalectomy has become in last decade “gold standard” for treating of adrenal tumors with diameters smaller than 6 cm. In addition, one should note that larger tumors or potentially malignant tumors, once considered contraindications to a laparoscopic approach, can now be removed laparoscopically, with virtually no complication. In many surgical centers a tumor size > 6cm is used as an indication for adrenalectomy.
Herein, the authors performed adrenalectomy over the past 5 years for 100 patients with adrenal pathology including incidentalomas, adenomas, Cushing disease, Cushing syndrome, Conn syndrome, pheochromocytomas and also neoplasia. Specifically, 32 patients (23 females and 9 males) between ages of 20 and 69 (median age of 46,43 years) had tumors larger than 6 cm diameter. 4 of these cases underwent bilateral adrenalectomy by laparoscopic approach whereas in 10 cases the surgeons preferred conversion to an open approach. Among the reasons for the conversion: bleeding, tumor size over 10 cm, cardiac arrhythmias, local invasion (inferior vena cava, liver, diaphragm), unclear landmarks, etc. The operating times were anywhere from 25 min to 270 min (median time 114,02 min) including patients with bilateral approach. Worth mentioning is also the fact that for the first cases the authors/surgeons first used monopolar dissector and then the LigaSure Atlas.
Mortality among the studied cases was zero and as postoperative complication only a bleeding from spleen (after bilateral adrenalectomy convert to open procedure because of unclear landmarks in a case of Cushing disease) can be mentioned. This spleen bleeding required reintervention for splenectomy and then pancreatic reaction (treated conservatively in the end). Patients were discharged anywhere between 1 and 50 days (the complicated case) postoperative (median 6 days).
In conclusion, the authors recommend that regardless of the nature and size of the tumor, surgeons should not delay conversion to open approach anytime there are signs of invasion or when the dissection has become difficult. Surgeon experience is a critical factor as well mainly because laparoscopic aderenalectomy is a quite difficult procedure and requires a more experienced surgeon when tumors are larger than 6-8 cm.

Session: Podium Presentation

Program Number: S060

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