Difficulties in Laparoscopic Adrenalectomy

  • Mahesh R. DesaiEmail author
  • Arvind P. Ganpule


Laparoscopic adrenalectomy is the method of choice in the majority of adrenal lesions. The open surgical approach for adrenal lesions requires a long skin incision, which at times may require muscle and rib cutting. The laparoscopic approach is quick and safe, the magnification offers excellent visibility, and blood loss is substantially decreased if the surgical technique is meticulous. Adrenalectomy is also one of the few laparoscopic procedures in which, due to the quick access to the area in question, has a shorter operative time. Although there is general agreement on use of this approach for benign and small lesions, the issue of the laparoscopic approach in adrenocortical carcinomas remains unresolved. This chapter discusses operative technique and troubleshooting measures.


  1. 1.
    Janetschek G, Altarac S, Finkenstedt G, Gasser R, Bartsch G. Technique and results of laparoscopic adrenalectomy. Eur Urol. 1996;30:475-479.CrossRefPubMedGoogle Scholar
  2. 2.
    Porpigilia F, Destefanis P, Fiori C, et al. Does adrenal mass size really affect safety and effectiveness of laparoscopic adrenalectomy? Urology. 2002;60:801-805.CrossRefGoogle Scholar
  3. 3.
    Chow GK, Blute ML. Surgery of the adrenal gland. In: Wein, Kavoussi, Novick, Partin, Peters, eds. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Saunders; 2007:1869.Google Scholar
  4. 4.
    Terachi T, Matsuda T, Terai A, et al. Transperitoneal laparoscopic adrenalectomy: experience with 100 patients. J Endourol. 1997;11:361-365.CrossRefPubMedGoogle Scholar
  5. 5.
    Suzuki K, Kayeyama S, Hirano Y, Ushiyama T, Rajamahanty S, Fujita K. Comparison of 3 surgical approaches to laparoscopic adrenalectomy: a nonrandomized background matched analysis. J Urol. 2001;166:437-443.CrossRefPubMedGoogle Scholar
  6. 6.
    Gasman D, Droopy S, Koutani A, et al. Laparoscopic adrenalectomy: the retroperitoneal approach. J Urol. 1998;159:1816-1820.CrossRefPubMedGoogle Scholar
  7. 7.
    Wajchenberg BL, Albergaria Pereira MA, Medonca BB, et al. Adrenocortical carcinoma: clinical and laboratory observations. Cancer. 2000;88(4):711-736.CrossRefPubMedGoogle Scholar
  8. 8.
    Udaya K, Gill IS, eds. Tips and Tricks in Laparoscopic Urology. London: Springer-Verlag; 2007:147-156.CrossRefGoogle Scholar
  9. 9.
    Fazeli-Matin S, Gill IS, Hsu TH, Sung GT, Novick AC. Laparoscopic renal and adrenal surgery in obese patients: comparison to open surgery. J Urol. 1999;162:665-669.CrossRefPubMedGoogle Scholar
  10. 10.
    Miller BS, Ammori JB, Ganger PG, Broome JT, Hammer GD, Doherty GM. Laparoscopic resection is inappropriate in patients with known or suspected adrenocortical carcinoma. [published online ahead of print April 7, 2010] World J Surg. doi: 10.1007/s00268-010-0532-2.
  11. 11.
    Gill IS. The case for laparoscopic adrenalectomy. J Urol. 2001;166:429-436.CrossRefPubMedGoogle Scholar
  12. 12.
    Soon PS, Yeh MW, Delbridge LW, et al. Laparoscopic surgery is safe for large adrenal lesions. Eur J Surg Oncol. 2008;34(1):67-70.CrossRefPubMedGoogle Scholar
  13. 13.
    National Institutes of Health. NIH state-of-the-science-statement on management of clinically inapparent adrenal mass (“incidentaloma”). NIH Consens State Sci Statements. 2002;19(2):1-25.Google Scholar
  14. 14.
    Sharma R, Ganpule A, Veermani M, Sabnis RB, Desai M. Laparoscopic management of adrenal lesions larger than 5 cm in diameter. Urol. J 2009;6(4):254-259.Google Scholar
  15. 15.
    Suzuki K, Ushiyama T, Mugiya S, Kageyama S, Saisu K, Fujita K. Hazards of laparoscopic adrenalectomy in patients with adrenal malignancy. J Urol. 1997;158(6):2227.CrossRefPubMedGoogle Scholar
  16. 16.
    de Lagausie P, Berrebi D, Michon J, et al. Laparoscopic adrenal surgery for neuroblastomas in children. J Urol. 2003;170:932-935.CrossRefPubMedGoogle Scholar
  17. 17.
    Greene FL, Kercher KW, Nelson H, Teigland CM, Boller AM. Minimal access cancer management. CA Cancer J Clin. 2007;57(3):130-146.CrossRefPubMedGoogle Scholar

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© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of UrologyMuljibhai Patel Urological HospitalNadladIndia
  2. 2.Division of Laparoscopic Surgery, Department of UrologyMuljibhai Patel Urological HospitalNadladIndia

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