Laparoscopic adrenalectomy for large pheochromocytoma.

OBJECTIVES: To determine the feasibility and safety of laparoscopic adrenalectomy for large adrenal pheochromocytomas as although the safety and efficacy for small pheochromocytomas is relatively well documented its use for large pheochromocytomas is controversial because of a perceived increased risk of malignancy. PATIENTS AND METHODS: All pheochromocytomas (>8 cm) managed prospectively using a laparoscopic approach between January 2002 and April 2006 were included. Blood loss, operative duration, complications, and hospital stay were assessed. RESULTS: In all, 11 consecutive patients underwent laparoscopic adrenalectomy for large pheochromocytomas. The adrenal sizes were 8-15 cm. The mean blood loss was <100 mL, the mean operative duration was 145 min and the mean postoperative stay was 3.6 days. Only one patient had an intraoperative hypertensive crisis, and recovery was uneventful in all. CONCLUSIONS: Laparoscopic transperitoneal, lateral adrenalectomy is safe and efficient means of resecting large (>8 cm) adrenal pheochromocytomas. Although intraoperative catecholamine surges are a cause of major concern, early clipping and dividing of the adrenal vein helps to avoid a catecholamine-induced hypertensive crisis.