Laparoscopic Left Adrenalectomy for Aldosteronoma: Early Mayo Clinic Experience
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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