Elsevier

Mayo Clinic Proceedings

Volume 70, Issue 9, September 1995, Pages 844-846
Mayo Clinic Proceedings

Laparoscopic Left Adrenalectomy for Aldosteronoma: Early Mayo Clinic Experience

https://doi.org/10.4065/70.9.844Get rights and content

Objective

To evaluate early results with laparoscopic left adrenalectomy in patients with an aldosteronoma.

Design

We retrospectively reviewed the medical records of Mayo patients in whom laparoscopic left adrenalectomy had been attempted for presumed aldosteronoma.

Material and Methods

Data on the diagnosis, details about the procedure, occurrence of associated complications, and duration of recovery period were analyzed for all study patients.

Results

Of the nine patients who underwent attempted laparoscopic left adrenalectomy, seven had aldosteronoma. In six of the seven patients, the procedure was successful. No preoperative mortality occurred, and morbidity was limited to prolonged ileus in one patient. Of the other five patients with successful results, all tolerated liquids within 24 hours after the procedure. The mean postoperative hospital stay for the six patients with successful laparoscopic procedures was 2.3 days, and four patients were dismissed within 48 hours after the procedure.

Conclusion

Laparoscopic adrenalectomy is a safe alternative for the management of aldosteronoma of the left adrenal gland.

Section snippets

Material and Methods

The medical records of all patients who underwent attempted laparoscopic left adrenalectomy for aldosteronoma were reviewed. Data on diagnosis, procedure, complications, and recovery were documented. Three groups of surgeons performed these procedures. Overall, nine laparoscopic left adrenalectomies have been attempted, seven of which were for the presumed diagnosis of left aldosteronoma.

Techniques

The patient position and trocar placement were based on the surgeon's preference. Five of the seven patients underwent adrenalectomy in the right lateral decubitus position. Three to five trocars were used. The lienophrenic ligament was divided to expose the left adrenal gland, and dissection was extended around the gland. For two procedures, the patients were in the supine position with a roll under the left flank. The omentum was reflected from the splenic flexure of the colon, and the colon

Results

Seven patients underwent attempted laparoscopic left adrenalectomy for presumed aldosteronoma, in six of whom the procedure was successful. The patient data are summarized in Table 1. The single failure, in the initial patient in the series, was caused by inadequate mobilization of the lienophrenic ligament to expose the adrenal gland. In this patient, a flank incision disclosed that the adrenal gland was superior to the level of dissection and adherent to the posterior aspect of the splenic

Discussion

Our results demonstrate the safety and efficacy of laparoscopic left adrenalectomy for managing selected patients with aldosteronoma. Previous studies have substantiated the feasibility of laparoscopic adrenalectomy,1, 2, 3, 4, 5 and our prior report suggested that the postoperative hospital stay might be decreased with this approach. Indeed, five of six patients who underwent successful laparoscopic adrenalectomy were able to be dismissed within 48 hours postoperatively. Three patients were

Conclusion

Our initial results with laparoscopic left adrenalectomy in patients with aldosteronoma are encouraging. In six of seven patients in whom the laparoscopic technique was attempted, the procedure was successful. Our results suggest that most patients can undergo successful left adrenalectomy for aldosteronoma with a brief postoperative stay and minimal postoperative discomfort.

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