CODE: 1 - Laparoscopic and open approach in the treatment of the adrenal tumors
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Zbigniew Wolski ¹, Magdalena Mikulska-Jovanović ¹, Maciej Gruszczyński ¹, Marek Jackowski ², Jacek Piątkowski ¹

¹ Katedra i Klinika Urologii Collegium Medicum w Bydgoszczy, UMK w Toruniu
² Katedra i Klinika Chirurgii Ogólnej i Gastroenterologicznej Collegium Medicum, UMK w Toruniu

summary

Introduction. From 1992, since Gargner and co. described the first laparoscopic adrenalectomy, this method became standard treatment of the operative removal of the adrenal tumor in selected clinical centers.

Objectives. The presentation of the first own experiences in the treatment of the adrenal tumors using laparoscopic and open approach.

Materials and methods. Between 1997 and 2005, 39 patients (22 women and 17 men) aged 33-77 (mean 55.2) underwent adrenalectomy due to primary and metastatic adrenal tumors. Between January 2002 and October 2005, 16 laparoscopic adrenalectomies (group 1) were performed using transperitoneal lateral approach, and from 1997 to April 2005, 23 open adrenalectomies (group 2). The indications for the operation were as follows: asymptomatic and symptomatic adrenal tumors with sizes above 3 cm and/or such that progress in repeated computer tomography examinations, and/or hormonally active. If the size of the adrenal tumors exceeded 6 cm the patient underwent open adrenalectomy. The preoperative work-up included close cooperation with endocrinologists for the hormonal evaluation of the tumors. In all cases, unilateral adrenalectomy was performed, in 15 on the left side and in 24 on the right side. In 25 patients the tumors were detected accidentally in the ultrasound examination. In 14 cases tumors were symptomatic (hypertension 6, symptoms of pheochromocytoma 4, Cushing syndrome 1, synchronic kidney tumor on the opposite side 2, pain 1). In both groups the length of the operation, the need for blood transfusion, the size of the tumors evaluated on CT and histopatological examination, the number of complications and the length of hospital stay were estimated.

Results. In the group I, the average length of the operations was 129 min (70-300); in the group II 135 min (105-180). In the postoperative histopathological examinations, the average size of the laparoscopically removed tumors was 3.55 cm (2.7-7) and in the open adrenalectomy group 5.5 cm (2.5-14). One laparoscopic adrenalectomy was converted to the open approach due to serious venous bleeding. In the group II, one patient underwent relaparotomy due to the bleeding in the first day after operation. The blood transfusion after laparoscopic adrenalectomy was necessary in two cases, after open approach in 9. The mean length of hospital stay of the patients in the group I was 3.7 days, and in the group II 8.8 days. In the postoperative pathological examination in the group I, 15 adenomas and one metastatic cancer from the lung were confirmed; in the group II 13 adenomas (one hormonally active with Cushing syndrome), 4 pheochromocytoma, 3 metastatic cancer from the kidney removed few years earlier, one primary adrenal cancer, one hematoma and one cystis were discovered. During follow-up there were no complications after laparoscopic adrenalectomy. After the open adrenalectomy, two patients had wound inflammation, and 3 till now complain of pain in the area of the postoperative scar.

Conclusions. 1. The first own experiences with the treatment of adrenal tumors using laparoscopic and open approach were presented. 2. In our departments, laparoscopic approach is currently the method of choice for removing the adrenal tumors sized up to 6 cm. 3. Correct qualification, preparation and perioperative care of the patients allows to carry out operations without complication using both approaches and gives uncomplicated post-operative follow-up. 4. Laparoscopic adrenalectomy allows to shorter length of hospital stay and quicker return to the normal activity, and also less painful convalescence.