Aims: To present our experience with resection of pheochromocytomas at the laparoscopic era, and evaluate the short-term and long-term results.
Methods: A total of 25 adrenalectomies for pheochromocytoma were performed between June 1997 and May 2008. The preoperative diagnosis, operative details, complications, length of hospital stay, morbidity and follow-up was docu mented from the hospital records of 150 patients who underwent adrenalectomies for benign and malignant adrenal tumors in the same period.
Results: Twenty-six tumors were removed from 25 patients (15 men and 10 women). The mean patient age was 53.08 years (range 22-72). The tumors were located at the left in 10 patients, at the right in 14 patients and one patient underwent bilateral resection of pheochromocytomas in two stages. The largest tumor excised laparoscopically was 10.5 cm. The diagnosis included 20 benign pheochromocytomas, 1 potentially malignant, 2 malignant and 2 as expression of MEN IIA syndrome. One patient had Recklinghausen disease. Nineteen patients underwent laparoscopic adrenalectomy, 1 patient had open approach from the start for recurrent malignant pheochromocytoma, 1 patient open biopsy due to inoperable malignant pheochromocytoma and 4 conversions from laparoscopic to open procedure. There were no conversions for the last 6 years. The mean hospital stay was 2 days (range 1-3) for the laparoscopic procedures. There was no hemodynamic instability in this series due to pneumoperitoneum. Five patients received sodium nitroprusside intraoperatively to treat hypertension. One patient developed pulmonary embolism after the operation, was hospitalised in the intensive care unit and succumbed 1 month later. There were no recurrences for the benign tumors.
CONCLUSIONS: Laparoscopic adrenalectomy for pheochromocytoma although safe, should be converted to open for difficult dissection, to avoid recurrence. Laparoscopic resection ofthese tumors needs experience in laparoscopic and adrenal surgery.