Laparoscopic adrenalectomy: An endocrinologist's perspective

Laparoscopic adrenalectomy is one of the most significant advances made in the past 20 years for the treatment of adrenal disorders. This minimally invasive approach to the adrenal gland has proven to be a useful technique for most nonmalignant adrenal disorders that require surgery. The key features of the lateral transabdominal laparoscopic approach are the insertion of trocars, the use of pneumoperitoneum, and tissue manipulation using video monitoring. Laparoscopic adrenalectomy is safe, effective, and curative; shortens hospitalization and convalescence; and produces less long- term morbidity than open adrenalectomy. The laparoscopic approach to the adrenal gland is the procedure of choice for the surgical management of aldosterone-producing adenomas, cortisol-producing adenomas, apparent nonfunctioning adrenal masses that require intervention, and pheochromocytomas, and for patients with adrenocorticotropin-dependent Cushing's syndrome in whom surgery to remove the source of adrenocorticotropic hormone has failed. The keys to successful laparoscopic adrenalectomy are appropriate patient selection, knowledge of anatomy, delicate tissue handling, meticulous hemostasis, and experience with the technique.