Laparoscopic Adrenalectomy

Abstract

In recent years, there has been a shift from open adrenalectomy toward laparoscopic adrenalectomy for the treatment of adrenal tumors due to such factors as decreased postoperative pain and faster recovery. Indeed, the majority of adrenalectomies in high-volume centers are performed laparoscopically. Indications for an adrenalectomy, whether open or laparoscopic, include a functional tumor, growth of an adrenal mass of 0.5 cm in 6 months based on imaging, adrenal tumor greater than 3–4 cm (since the risk of adrenal carcinoma increases with increasing tumor size), and isolated metastatic disease. The indications for laparoscopic adrenalectomy are essentially the same as those for open adrenalectomy with the notable exception of adrenocortical cancer, malignant pheochromocytoma, and large metastases. However, as skill and experience with laparoscopy increases, many authors have advocated laparoscopic adrenalectomy even for malignant disease. Contraindications for laparoscopic adrenalectomy also include general contraindications to laparoscopic procedures (such as severe cardiopulmonary risk and coagulopathy).