Laparoscopic adrenalectomy for pheochromocytoma: is it really more difficult?

OBJECTIVE: Laparoscopic adrenalectomy (LA) has become the gold standard technique for almost all the adrenal masses, but several Authors still debate about LA in pheochromocytoma. BACKGROUND: The purpose of this study was to compare feasibility and safety of LA for pheo and analyze the results relative to LA for incidentaloma, Conn's disease and Cushing's disease. METHODS: Between January 1994 and March 2006, 167 LAs were carried out in 160 consecutive patients at our Department and 46 of them were affected by pheo, 60 by Conn's disease, 34 by adrenal incidentaloma and 20 by Cushing's disease. The following parameters were statistically analysed: Side and size of lesion, conversion to open adrenalectomy (OA), operating time, length of hospital stay, intraoperative blood pressure variations, blood loss, blood transfusion, need for postoperative analgesia, resumption of oral nutrition and postoperative complications. RESULTS: Successful LA was performed in 159 out of 167 cases (95.2%). Significant statistical advantages were observed for pheo, even if its average size was larger (p > 0.001), in terms of average operating time (p < 0.001), average length of hospital stay (p < 0.001), average intraoperative blood loss (p > 0.001), postoperative analgesia (p < 0.001), oral nutrition (p < 0.001). LA for patients with Cushing's disease (average length of hospital stay and intraoperative blood loss, p < 0.023 and p > 0.002 respectively) and with adrenal incidentaloma (intraoperative blood loss p < 0.009) seems to be a more challenging procedure. CONCLUSION: The evaluation of this relatively large monoinstitutional experience suggests that LA could be considered the most suitable method for removing pheochromocytoma. This tumour tends to be larger than most functional cortical adenomas, nevertheless it allows even a significant reduction in operating time with a faster recovery.