Laparoscopic Retroperitoneal Adrenalectomy

Abstract

Introduction: Laparoscopic adrenalectomy is the most frequently used management option for adrenal pathologies. For benign conditions we have been able to do it within a 24 hour inpatient period. We describe the rationale, clinical pathway, surgical technique and discharge criteria. Purpose: To describe our clinical pathway and surgical management to perform laparoscopic retroperitoneal adrenalectomy. Materials and Methods: All patients are assessed with axial imaging and adrenal function panel. We exclude patients with significant co-morbidities. All patients are pre-assessed, consented and admitted two hours prior to surgery. The laparoscopic adrenalectomy is done retroperitoneally to avoid ileus. If observations and blood tests are normal and oral intake resumed the patients are discharged with postoperative instructions. Results: All patients were medically fit for discharge within the first 24 hours. The surgical pathway and selection is well standardized, reproducible and easy to teach and learn. patients with Conn's syndrome normalized the blood pressure and did not have episodes of postural hypotension after the first 12 postoperative hours. Comprehensive pre and postoperative information, is essential to cover patients' expectations and to avoid anxieties of an early discharge. Conclusions: Day case laparoscopic retroperitoneal adrenalectomy for benign conditions is feasible. The surgical pathway is simple, reproducible and cost effective. Recovery for domiciliary discharge is achieved within 24 hours in the vast majority of selected patients.