Laparoscopic Adrenalectomy: Transabdominal or Retroperitoneal

Abstract

Adrenalectomy is indicated for treatment of various functioning and non-functioning adrenal tumours or diseases. Majority of adrenalectomy is performed for relatively small functioning tumours. There had been continuous evolution of the open surgical approaches from the transabdominal to lateral and then posterior retroperitoneal approach in the pre-minimally invasive era. The posterior approach was adopted as the procedure of choice for the majority of patients with benign small adrenal tumours based on reduced invasiveness until the report of first successful laparoscopic adrenalectomy in 1992 (1). Despite the lack of randomized controlled trials to document its advantages over open surgical approach, subsequent experience has confirmed the advantages of minimally invasive adrenalectomy in terms of decreased blood loss, less morbidity, reduced hospital stay and a shorter recovery time as well as a greater patient satisfaction (2,3,4,5,6). Since then, laparoscopic adrenalectomy has become the standard surgical approach for patients with benign or relatively small adrenal tumours requiring adrenalectomy although the application of this technique for large or malignant tumours remains a controversial issue for its routine application.