Laparoscopic Adrenalectomy: An Update

Overview

Journal Arab J Urol

Date 2015 Nov 12

PMID 26558005

Citations 5

Authors

Hassan Mesfer Al-Zahrani

Affiliations

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Abstract

Objective: To review the current role and outcome of laparoscopic adrenalectomy (LA) in the management of adrenal tumours.

Methods: A Medline search using the keywords (adrenalectomy, laparoscopy, adrenal masses/tumours) was done for reports published between 1990 and 2011. Key articles were used to find more relevant references on the evaluation and laparoscopic management of adrenal masses.

Results: The hormonal evaluation is not standardised, but initial screening tests are recommended and followed with confirmatory ones when positive, equivocal or the clinical presentation suggest adrenal hyperfunction. The imaging studies had, and continued to, advance, especially computed tomography (CT), magnetic resonance imaging and positron-emission tomography/CT. These advances have increased the accuracy of the diagnosis of adrenal masses, with a reported high sensitivity and specificity of 95-100%. The introduction of laparoscopy has resulted in more adrenal lesions being removed, especially incidental lesions smaller than the 5-6 cm that was previously the indication for surgical excision. The technique has developed and larger lesions of >6 cm are now considered for LA in the proper setting. The transperitoneal and retroperitoneal approaches are currently widely practised, with minor differences in the outcome. The reported outcome, although mostly retrospective, is excellent and with fewer complications. The role of LA for adrenal malignancy should be considered cautiously. Preoperative imaging signs of invasion into surrounding structures should be considered a contraindication for LA.

Conclusion: LA is the standard procedure for most adrenal lesions of appropriate size and no signs of surrounding tissue invasion, giving an excellent outcome.

Citing Articles

Comparison of lateral transperitoneal and retroperitoneal approaches for homolateral laparoscopic adrenalectomy.

Liu Z, Li D, Yan L, Xu Z, Gu G BMC Surg. 2021; 21(1):432.

PMID: 34930214 PMC: 8686258. DOI: 10.1186/s12893-021-01422-w.

Applicability and outcome of laparoscopic adrenalectomy for large tumours.

Mohammed A, Amine H, El Atiq S, Mohammed B, Ouadii M, Khalid M Pan Afr Med J. 2019; 31:23.

PMID: 30918550 PMC: 6430842. DOI: 10.11604/pamj.2018.31.23.15153.

Management and prognosis of adrenocortical tumors in children: can we find out an appropriate points-scoring system to predict prognosis?.

Ru W, Yang M, Xu S, Li M, Tang D Pediatr Surg Int. 2017; 33(6):705-711.

PMID: 28260193 DOI: 10.1007/s00383-017-4073-8.

Laparoscopic left and right adrenalectomy from an anterior approach - is there any difference? Outcomes in 176 consecutive patients.

Kokorak L, Soltes M, Vladovic P, Marko L Wideochir Inne Tech Maloinwazyjne. 2017; 11(4):268-273.

PMID: 28194247 PMC: 5299086. DOI: 10.5114/wiitm.2016.64767.

Feasibility and safety of laparoscopic adrenalectomy for large tumours.

Serji B, Souadka A, Benkabbou A, Hachim H, Jaiteh L, Mohsine R Arab J Urol. 2016; 14(2):143-6.

PMID: 27489741 PMC: 4963158. DOI: 10.1016/j.aju.2016.04.003.

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