The Comparison of Laparoscopic Adrenalectomy with Open Adrenalectomy

Seo, In Young; Kye, Bong Hyeon; Kim, Jun Gi; Heo, Youn Jung; Cho, Hyeon Min; Park, Jung Hyeon; Jun, Kyung Hwa; Suh, Young Jin; Won, Yong Sung; Chin, Hyung Min; Park, Woo Bae; Chun, Chung Soo

Abstract

PURPOSE: The purpose of our study was to compare the outcomes of patients who had undergone a conventional open adrenalectomy (OA) with those who had undergone a laparoscopic adrenalectomy (LA).
METHODS
We retrospectively reviewed 66 patients who underwent an adrenalectomy between 1990 and 2005. The study group was comprised of 41 laparoscopic cases with 25 open adrenalectomy cases comprising the control group. The parameters studied included the operating times, transfusion volumes, time to resumption of a soft diet, total frequency of analgesics, time to return to free ambulation and length of hospital stay in both the OA and LA groups.
RESULTS
No mortality was observed in either the OA or LA groups. The operating times were, on average, 203.1+/-64.5 and 158.2+/-76.4 minutes in the OA and LA group, respectively (P=0.011). 10 cases in the OA group needed a transfusion (average: 438.52+/-687.57 ml), but two cases including one require conversion to a celiotomy, due to a right renal vein injury, needed a transfusion (average: 23.41+/-110.63 ml)(P=0.004). The patients of the OA and LA groups began soft diets on the 4.8+/-1.1 (3~7 days) and 2.7+/-1.5 postoperative days (1~8 days), respectively (P=0.004). Total frequencies of analgesics were 9.5+/-6.5 and 4.4+/-4.7 in the OA and LA groups, respectively (P=0.001). The times needed to return to free ambulation were 7.6+/-3.8 and 4.3+/-2.3 days in the OA and LA groups, respectively (P= 0.000). Postoperative hospital stays were 16.3+/-7.5 and 7.3+/-2.3 days in the OA and LA groups, respectively (P=0.000).
CONCLUSION
An LA appears to be a safe and effective approach for patients with various adrenal pathologies and large sized adrenal lesions. We expect the indications for an LA may be extended to large adrenal tumors as well as primary or metastatic malignant adrenal lesions if the oncologic principles are obeyed.