Laparoscopic bilateral anterior transperitoneal adrenalectomy: 24 years experience

  • Andrea BallaEmail author
  • Monica Ortenzi
  • Livia Palmieri
  • Diletta Corallino
  • Francesca Meoli
  • Pietro Ursi
  • Giulia Puliani
  • Emilia Sbardella
  • Andrea M. Isidori
  • Mario Guerrieri
  • Silvia Quaresima
  • Alessandro M. Paganini



The aim of this study is to evaluate the feasibility, safety, advantages and surgical outcomes of laparoscopic bilateral adrenalectomy (LBA) by an anterior transperitoneal approach.


From 1994 to 2018, 552 patients underwent laparoscopic adrenalectomy, unilateral in 531 and bilateral in 21 patients (9 females and 12 males). All patients who underwent LBA were approached via a transperitoneal anterior route and form our study population. Indications included: Cushing’s disease (n = 11), pheochromocytoma (n = 6), Conn’s disease (n = 3) and adrenal cysts (n = 1).


Mean operative time was 195 ± 86.2 min (range 55–360 min). Conversion was necessary in one case for bleeding. Three patients underwent concurrent laparoscopic cholecystectomy with laparoscopic common bile duct exploration and ductal stone extraction in one. Three postoperative complications occurred in one patient each: subhepatic fluid collection, intestinal ileus and pleural effusion. Mean hospital stay was 6.1 ± 4.7 days (range 2–18 days).


In our experience, transperitoneal anterior LBA was feasible and safe. Based on our results, we believe that this approach leads to prompt recognition of anatomical landmarks with early division of the main adrenal vein prior to any gland manipulation, with a low risk of bleeding and without the need to change patient position. Unlike the lateral approach, there is no need to mobilize the spleno-pancreatic complex on the left or the liver on the right. The ability to perform associated intraperitoneal procedures, if required, is an added benefit.


Laparoscopic bilateral adrenalectomy (LBA) Laparoscopic transperitoneal anterior adrenalectomy Laparoscopic transperitoneal anterior submesocolic left adrenalectomy 



The authors are grateful to Professor Abe Fingerhut for his critical review of this manuscript.


Dr. Andrea Balla, Dr. Monica Ortenzi, Dr. Livia Palmieri, Dr. Diletta Corallino, Dr. Francesca Meoli, Dr. Pietro Ursi, Dr. Giulia Puliani, Dr. Emilia Sbardella, Prof. Andrea M. Isidori, Prof. Mario Guerrieri, Dr. Silvia Quaresima and Prof. Alessandro M. Paganini declare that they have no conflict of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Andrea Balla
    • 1
    Email author
  • Monica Ortenzi
    • 2
  • Livia Palmieri
    • 1
  • Diletta Corallino
    • 1
  • Francesca Meoli
    • 1
  • Pietro Ursi
    • 1
  • Giulia Puliani
    • 3
  • Emilia Sbardella
    • 3
  • Andrea M. Isidori
    • 3
  • Mario Guerrieri
    • 2
  • Silvia Quaresima
    • 1
  • Alessandro M. Paganini
    • 1
  1. 1.Department of General Surgery and Surgical Specialties “Paride Stefanini”Sapienza University of RomeRomeItaly
  2. 2.Department of General SurgeryUniversità Politecnica delle MarcheAnconaItaly
  3. 3.Department of Experimental MedicineSapienza University of RomeRomeItaly

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