Ces Urol 2013, 17(4):246-253 | DOI: 10.48095/cccu2013031

Laparoscopic adrenalectomy at the Olomouc University Hospital - a 15-year experience

Igor Hartmann¹, Michal Grepl¹, Oldřich Šmakal¹, Filip Čtvrtlík², Jan Václavík³, Zdeněk Fryšák⁴, Martin Doležel⁵, Vladimír Študent¹

¹ Urologická klinika FN a LF UP, Olomouc

² Radiologická klinika FN a LF UP, Olomouc

³ 1. interní klinika, FN a LF UP, Olomouc

⁴ 3. interní klinika NRE, FN a LF UP, Olomouc

⁵ KOC Pardubická krajská nemocnice a.s. a Multiscan s.r.o., Pardubice

Aim:
Since its introduction in 1992, laparoscopic adrenalectomy has virtually replaced the open adrenalectomy. The Department of Urology of the Olomouc University Hospital has been one of the first to routinely perform this procedure in the Czech Republic. The aim of this study was to review outcomes of patients undergoing laparoscopic adrenalectomy at this Center.

Methods:
We performed a retrospective analysis of the medical records from patients who underwent laparoscopic adrenalectomy at the center from 1998-2012.

Results:
Over the 15-year period, a total of 250 laparoscopic adrenalectomies were performed. Of those, 132 (53%) were carried out in females and 113 (45%) in males. Bilateral adrenalectomy was performed in 7 cases. The patients' mean age was 56 years (range, 20-79 years). Seventy-eight cases (31%) were incidentalomas without any hormonal activity. In the remaining 172 (69%) cases, adrenal hormone overproduction was detected. All patients were examined using imaging methods (CT, MRI, PET/CT). Selective catheterization of the adrenal veins was carried out in 51 (20%) patients. In most cases, this diagnostic procedure was indicated to identify the source of aldosterone overproduction. In 52% of patients with hyperaldosteronism, the method was necessary to determine the side of surgery. Right and left adrenalectomies were performed in 120 (48%) and 130 (52%) cases respectively. In 8 (3%) of patients, partial adrenalectomy was indicated. The mean maximal diameter of the removed adrenals was 51mm (range, 21-122 mm). A mean operating time (skin-to-skin) was 54 minutes (38-200 minutess). Sixteen (6.4%) patients had to be treated for Clavien grade III early postoperative complications. The surgery was associated with zero mortality. Associated laparoscopic cholecystectomy was performed in 4 cases and bilateral adnexectomy was performed in 1 case.

Conclusion:
Laparoscopic adrenalectomy is a safe procedure with low complication rates. Ideally, it should be used for tumours sized less than 12 cm with no signs of invasive growth.

Keywords: adrenalectomy, laparoscopy, adrenal tumours

Received: May 19, 2013; Accepted: June 12, 2013; Published: September 1, 2013