Retroperitoneoscopic Adrenal Surgery with Reusable Instruments

Abstract

Background and Purpose

: Retroperitoneoscopic surgery has proven advantages over open surgery in terms of cosmesis, reduced postoperative pain, hospital stay, and early return to work. This is particularly true for surgery of the adrenal gland that otherwise entails a large surgical incision. One of the drawbacks of this surgery is the additional cost attributable to the disposable instruments. We present our cost-reductive retroperitoneoscopic techniques to tackle a variety of adrenal pathologies.

Patients and Methods

: Beginning March 1995, 17 patients underwent cost-reductive retroperitoneoscopic adrenal surgery for various indications including 12 pheochromocytomas, 3 myelolipomas, 2 adrenal cortical adenomas, and two adrenal cysts. Two patients underwent simultaneous bilateral procedures for pheochromocytoma. A cost-reductive technique using minimal disposable equipment was employed.

Results

: The procedure was completed in 18 of 19 cases (94%). One patient undergoing an adrenalectomy for pheochromocytoma was converted to open surgery because of nonprogress of the dissection. The largest tumor removed measured 10 cm. The mean operative time was 133 minutes, the average blood loss 169 mL, NSAID doses 3.56, and hospital stay 4.6 days. There were two major and two minor complications with no deaths.

Conclusions

: Cost-reductive retroperitoneoscopy is a feasible option for the management of a variety of adrenal pathologies. It should be considered a difficult procedure and be undertaken only by surgeons proficient in laparoscopy.