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2012 ; 10
(1
): 56-65
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Laparoscopic adrenalectomy: An update
#MMPMID26558005
Al-Zahrani HM
Arab J Urol
2012[Mar]; 10
(1
): 56-65
PMID26558005
show ga
OBJECTIVE: To review the current role and outcome of laparoscopic adrenalectomy
(LA) in the management of adrenal tumours. METHODS: A Medline search using the
keywords (adrenalectomy, laparoscopy, adrenal masses/tumours) was done for
reports published between 1990 and 2011. Key articles were used to find more
relevant references on the evaluation and laparoscopic management of adrenal
masses. RESULTS: The hormonal evaluation is not standardised, but initial
screening tests are recommended and followed with confirmatory ones when
positive, equivocal or the clinical presentation suggest adrenal hyperfunction.
The imaging studies had, and continued to, advance, especially computed
tomography (CT), magnetic resonance imaging and positron-emission tomography/CT.
These advances have increased the accuracy of the diagnosis of adrenal masses,
with a reported high sensitivity and specificity of 95-100%. The introduction of
laparoscopy has resulted in more adrenal lesions being removed, especially
incidental lesions smaller than the 5-6 cm that was previously the indication for
surgical excision. The technique has developed and larger lesions of >6 cm are
now considered for LA in the proper setting. The transperitoneal and
retroperitoneal approaches are currently widely practised, with minor differences
in the outcome. The reported outcome, although mostly retrospective, is excellent
and with fewer complications. The role of LA for adrenal malignancy should be
considered cautiously. Preoperative imaging signs of invasion into surrounding
structures should be considered a contraindication for LA. CONCLUSION: LA is the
standard procedure for most adrenal lesions of appropriate size and no signs of
surrounding tissue invasion, giving an excellent outcome.