Laparoscopic versus open adrenalectomy: 30 year experience in 88 patients

Aims: The aim was to conduct a clinical review of the results of laparoscopic and open adrenalectomy in the treatment of adrenal gland pathology at The Canberra Hospital and to examine our hypothesis that laparoscopic adrenalectomy had greater clinical and cost effectiveness than open adrenalectomy. Methods: This was a retrospective study. Eighty eight unilateral and bilateral laparoscopic and open adrenalectomy patients were studied between 1980 to 2010. Assessment included demographics, operative indications, operative time, estimated blood loss, post operative complications, post operative hospital days and mean costs including operation cost, bed stay costs and total costs. Results: Common indications were adrenal cortical adenoma (n=29) and phaeochromocytoma (n=23). Compared with open, lapararoscopic adrenalectomy had smaller average blood loss (231ml ±SD 243ml compared with 542ml ±SD 658ml, p<0.04), shorter hospital stay (5.5 days ±SD 3.8 days compared with 9.9 days ±SD 3.9 days, p<0.01) and fewer complications. Average total costs were lower in laparoscopic than open ($22,785 ±SD 8652 compared with $29,684 ±SD 10026, p<0.02). Conclusion: Results confirm the safety, reliability and cost effectiveness of laparoscopic more than open adrenalectomy in the treatment of adrenal gland pathology. It justifies the laparoscopic approach as an appropriate and viable option for patients requiring adrenalectomy when indicated.