Indications for adrenalectomy in the laparoscopic era.

The tilt from open to laparoscopic surgery seems to be definite in most adrenal disorders. The aim of this study is to evaluate the current indications for laparoscopy and the persistent indications for open adrenalectomy, as seen in our experience and in the literature data. Between January 1985 and December 1999, 486 patients were operated on for adrenalectomy. Since January 1994, 91 laparoscopic adrenalectomies were performed in 84 patients. The Authors retrospectively evaluated the indications for laparoscopy in 55 patients (45.9%) and for open adrenalectomy in 65 others (54.1%) operated on in the last three years. Exclusion criteria for the laparoscopic approach included clinical suspicion of malignancy and tumour size greater than 6 cm, in the 38.5% and in the 23.0% of cases respectively. In Authors experience the laparoscopic adrenalectomy is the procedure of the choice for the surgical removal of non-malignant, unilateral or bilateral tumours under 6 or 7 cm. The laparoscopy is not a radical operation for cancer. Open surgery is always indicated for large and malignant tumours. The fascinating feature of laparoscopy has not to change the indications and the surgeon must plan the appropriate approach for every single patient