A Comparison of Laparoscopic and Open Adrenalectomies

Abstract

OBJECTIVE: To compare the relative merits of conventional transabdominal and posterior methods with a laparoscopic approach for adrenalectomy. DESIGN: A retrospective cohort study of consecutive series of patients having unilateral adrenalectomy for lesions less than 10 cm in diameter. SETTING: University hospital. PATIENTS: Ten patients who underwent laparoscopic adrenalectomy: 11, transabdominal adrenalectomy; and 13, posterior adrenalectomy. MAIN OUTCOME MEASURES: Operative time, estimated blood loss, length of hospital stay, and postoperative parenteral analgesic need. RESULTS: There was no significant difference in the operative time for laparoscopic and anterior adrenalectomy (mean +/- SD, 212 +/- 77 minutes vs 174 +/- 41 minutes), but the time for posterior adrenalectomy was significantly shorter (139 +/- 36 minutes) (P < .01). The mean (+/- SD) hospital stay after laparoscopic removal (2.1 +/- 0.9 days) was significantly shorter than the stay after anterior (6.4 +/- 1.5 days) and posterior (5.5 +/- 2.9 days) adrenalectomy. The postoperative need for parenteral pain medication as measured by the number of doses and the total milligrams of meperidine hydrochloride administered was significantly less with laparoscopic adrenalectomy compared with either open procedure (P < .0001). CONCLUSIONS: Laparoscopic adrenalectomy may take longer to perform than conventional open approaches but it has clear-cut advantages in shortening postoperative hospital stay and lessening postoperative analgesic requirements. It may be the preferred method for most patients requiring adrenalectomy.