Laparoscopic adrenalectomy in children: a multicenter experience

Laparoscopic adrenalectomy in children: a multicenter experience

Laparoscopic adrenalectomy is now being recognized as the standard approach for adrenalectomy for benign lesions in adults. The published experience in children and adolescents has been limited to sporadic small case series. Therefore, we conducted a large multicenter review of children who have und...

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Bibliographic Details
Published in:Journal of laparoendoscopic & advanced surgical techniques. Part A Vol. 21; no. 7; p. 647
Main Authors: St Peter, Shawn D, Valusek, Patricia A, Hill, Sarah, Wulkan, Mark L, Shah, Sohail S, Martinez Ferro, Marcello, Bignon, Horatio, Laje, Pablo, Mattei, Peter A, Graziano, Kathleen D, Muensterer, Oliver J, Pontarelli, Elizabeth M, Nguyen, Nam X, Kane, Timothy D, Qureshi, Faisal G, Calkins, Casey M, Leys, Charles M, Baerg, Joanne E, Holcomb, George W
Format: Journal Article
Language:English
Published: United States 01-09-2011
Subjects:
Adolescent
Adrenalectomy - methods
Adult
Child
Child, Preschool
Female
Humans
Infant
Laparoscopy
Male
Retrospective Studies
Young Adult
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Summary:Laparoscopic adrenalectomy is now being recognized as the standard approach for adrenalectomy for benign lesions in adults. The published experience in children and adolescents has been limited to sporadic small case series. Therefore, we conducted a large multicenter review of children who have undergone laparoscopic adrenalectomy. After Institutional Review Board's approval, a retrospective review was conducted on all patients who have undergone laparoscopic adrenalectomy at 12 institutions over the past 10 years. Operative times included unilateral adrenalectomy without concomitant procedures. About 140 patients were identified (70 males [50%]). Laterality included 76 (54.3%) left-sided lesions, 59 (42.1%) right, and 5 (3.6%) bilateral. Mean operative time was 130.2 ± 63.5 minutes (range 43-406 minutes). The most common pathology was neuroblastoma in 39 cases (27.9%), of which 23 (59.0%) had undergone preoperative chemotherapy. Other common pathology included 30 pheochromocytomas (21.4%), 22 ganglioneuromas (15.7%), and 20 adenomas (14.3%). There were 13 conversions to an open operation (9.9%). Most conversions were because of tumor adherence to surrounding organs, and tumor size was not different in converted cases (P=.97). A blood transfusion was required in 2 cases. The only postoperative complication was renal infarction after resection of a large neuroblastoma that required skeletonization of the renal vessels. At a median follow-up of 18 months, there was only one local recurrence, which was in a patient with a pheochromocytoma. The laparoscopic approach can be applied for adrenalectomy in children for a wide variety of conditions regardless of age with a 90% chance of completing the operation without conversion. The risk for significant blood loss or complications is low, and it should be considered the preferred approach for the majority of adrenal lesions in children.
ISSN:1557-9034
DOI:10.1089/lap.2011.0141