Laparoscopic adrenalectomy: Experience in a tertiary care hospital in Eastern India

Introduction: Laparoscopic adrenalectomy is considered the gold standard technique for the surgical removal of the diseased adrenal gland. We evaluate our experience in laparoscopic adrenalectomy with special emphasis on efficacy, safety and learning curve with this technique.

Materials and Methods: A total of 24 patients undergone lateral transperitoneal laparoscopic adrenalectomy for various adrenal disorder in our institution. Patient’s demographics, tumor characteristics, operating times, surgical outcomes, complications, recovery and length of hospital stay were studied. All patients undergone through history and physical examinations. Investigations like ultrasound (USG) of whole abdomen, contrast enhanced computerized tomogram (CECT) of abdomen were done in every patient and magnetic resonance imaging in selected patients. Serum cortisol levels and 24 hours urinary free cortisol were estimated in every patient, and 24 hours fractionated urinary metanephrines, plasma free metanephrine, normetanephrines and /or Vanillyl mandelic acid (VMA) levels were performed selectively in suspected pheochromocytoma. Aldosterone to renin ratio (ARR), only in patients with hypertension or hypokalemia.

Results: Laparoscopic adrenalectomy was conducted in 24 patients of whom two patients needs open conversion due to uncontrolled intraoperative bleeding from right adrenal vein which was torn at its junction from inferior vena cava (IVC). The patients were in the age range of 22 to 67 years, Complications in post-operative periods occurred in four patients: one patient had lung atelectasis, one patient had wound infection, one patient had port site infection and one patient developed post-operative hypotension. All patients were managed conservatively.  No patients had hepatic, renal, bowel, pancreatic or splenic injuries. Right sided adrenalectomies were nine and left sided adrenalectomies were fifteen. Mean operative time was 160 minutes and ranged from 130-200 minutes. Mean operative blood loss was 120 ml and ranged from 100-160 ml. Mean post-operative analgesic requirements for laparoscopic adrenalectomies were significantly less, with 50 mg tramadol hydrochloride twice daily for first 36 hours. Oral intake of fluid was given mostly six hours after operation and diet were given when oral liquid was tolerated after an average of two (1-3) days. Duration of hospital stay ranged from 3-5 days (median 2.5 days).

Conclusions: Laparoscopic adrenalectomy is a relatively easy, safe, cost- effective, less morbid procedure. Lateral transperitoneal approach offers advantages including better visibility and easy access to other abdominal organ system. Hence it becomes gold standard for most of the benign adrenal diseases and in some malignant tumors in hand of expert and experienced surgeons irrespective of size of the tumors.