Laparoscopic Adrenalectomy for Large Adrenal Tumors.

From April 2010 to October 2018, preoperative and postoperative data of 107 patients who underwent LTA with adrenal mass were recorded prospectively and analyzed retrospectively.

The inclusion criteria were all hormonally active adrenal lesions, detection of increases in size in < 4 cm adrenal tumors on serial imaging, solitary adrenal metastases without evidence of local invasion, tumors size ≥ 4 cm, patients between the age of 18 and 80, and American Society of Anesthesiologists score (ASA) ≤ 3. The patients with adrenal masses that specified suspicion of malignancy on imaging such as local invasion, irregular tumor margins were evaluated as ineligible for LTA, and excluded in this study, were addressed to open surgery. Retroperitoneoscopic and laparoscopic partial adrenalectomies were also excluded from the study.

Totally 102 patients were included in the study. The patients were allocated according to adrenal tumor size as <6cm (group 1:76) and ≥ 6 cm (group 2: 26). The variables such as demographics, tumor size, and laterality, operation time, blood loss, per-operative and postoperative complications, length of hospital stay, final pathology result were compared between the two groups. In order to evaluate the learning curve, the patients were also classified into three consecutive groups including group A (1-25), group B (25-50), group C (51-75) and group D (76-102) according to the chronological order of their surgery. Variables including operation time, tumor size, blood loss, and hospital stay, and overall complications were used to investigate the learning curve.

Inclusion criteria

• all hormonally active adrenal lesions,
• detection of increases in size in < 4 cm adrenal tumors on serial imaging,
• solitary adrenal metastases without evidence of local invasion,
• tumors size ≥ 4 cm,
• patients between the age of 18 and 80
• American Society of Anesthesiologists score (ASA) ≤ 3.

Exclusion criteria

• suspicion of malignancy on imaging such as local invasion, irregular tumor margins
• Retroperitoneoscopic adrenalectomies
• laparoscopic partial adrenalectomies