Is Laparoscopic Adrenalectomy Safe in Large Adrenal Masses?

Özet

Objective: We aimed to investigate the reliability and effectiveness of laparoscopic adrenalectomy (LA) in large adrenal masses by comparing LA results for large- and small-volume (<5 cm) masses. Materials and Methods: Patients who underwent LA due to adrenal mass between February 2004 and December 2018 in our clinic were retrospectively analyzed. The patients were divided into two groups as mass size <5 cm (group I) and ≥5 cm (group II). Patients who underwent open adrenalectomy and whose data were not available were excluded from the study. Perioperative data, postoperative results, complications, and histopathological results were examined. Results: There were 62 patients who underwent LA. Thirty-three patients (53.2%) had a left adrenal mass, and 29 patients (46.8%) had a right adrenal mass. Of the 62 adrenal masses, 46 (74.2%) had a diameter of <5 cm (group I), and 16 (25.8%) were ≥5 cm (group II). The mean tumor size was 3.2±0.15 and 6.4±3.5 cm in group I and group II, respectively. There was no statistically significant difference between the groups in terms of age, operative time, and blood loss. The average length of hospital stay was 37.6±20.9 hours in group I, while it was 49.8±22.9 hours in group II and was significantly longer in group II (p<0.05). Intraoperative blood pressure elevation occurred in one patient in group I and II. In a patient with suspected malignancy in group II, the surgery was shifted to open surgery as the capsule over the mass was opened. Hypopotasemia was observed in one patient, and atelectasis was observed in one patient in group I, and pneumonia was observed in one patient in group II. Conclusion: LA is a minimally invasive surgical method that can be applied safely in experienced centers in masses larger than 5 cm with no suspected invasion in preoperative imaging.