LAPAROSCOPIC SURGICAL TREATMENT FOR ADRENAL TUMORS, A RETROSPECTIVE ANALYSIS

Abstract

Objective. Laparoscopic adrenalectomy has rapidly replaced open adrenalectomy as the procedure of choice for benign adrenal tumors. The aim of this study was to evaluate the long-term results of 105 consecutive laparoscopic and open adrenalectomies performed during a period of 14.5 years at the University Clinic of Urology in Skopje. We aimed to present our experience with this procedure. In addition, we compare the clinical outcomes of laparoscopic (LA) vs. the open adrenalectomies (OA) performed at our institution. Patients and methods: A retrospective analysis of patients operated on for adrenal tumors was conducted. From May 2005 to August 2020, one hundred adrenalectomies were performed on 105 patients since laparoscopic adrenal surgery was introduced in our country. There were 48 men and 57 women, aged 23 to 73 years. All patients were assessed regarding their demographic data, hormonal status, operative time, estimated blood loss, complications, size of the tumor, number of patients requiring blood transfusion, hospital stay and conversion to open surgery for LA. Results: In 93 patients, the laparoscopic procedure was completed successfully. In 12 cases, the laparoscopic procedure was converted to an open one. Operative time for laparoscopic adrenalectomies ranged from 45 to 120 minutes. The average postoperative hospital stays for laparoscopic adrenalectomy ranged from 1 to 2 days (1.5 days), versus 5 to 20 days for patients who underwent the open or converted procedure. LA proved superior to OA, resulting in less estimated blood loss, shorter operating time, shorter time to resumption of oral intake, shorter postoperative hospital stay and less analgesic requirements. During the follow-up of 3 to 96 months, no tumor recurrence and/or metastasis developed. Conclusions: Laparoscopic adrenalectomy should be the treatment of choice for all benign adrenal tumors. Laparoscopic resection of large adrenal tumors necessitates experience in open and advanced laparoscopic surgery. Our results concur with other retrospective reviews comparing laparoscopic and open adrenalectomy, demonstrating unequivocal advantages in terms of reduced length of hospital stay, blood loss, return of bowel function, functional recovery, and post-operative morbidity