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Invited Commentary
November 2018

Laparoscopic Transabdominal Adrenalectomy—A Procedure That Has Stood the Test of Time

Author Affiliations
  • 1Section of Endocrine Surgery, David Geffen School of Medicine at University of California, Los Angeles
JAMA Surg. 2018;153(11):1042. doi:10.1001/jamasurg.2018.2674

Laparoscopic transabdominal adrenalectomy was first reported by Gagner et al1 in 1992, and it has since become the standard of care for removal of benign adrenal nodules. Compared with open adrenalectomy, the laparoscopic approach has been consistently associated with decreased morbidity (particularly pulmonary and wound complications) and faster recovery.2,3 In the current issue of JAMA Surgery, Chen et al4 describe what is, to our knowledge, the largest single-institution experience of laparoscopic transabdominal adrenalectomy to date. The authors demonstrate that this is a safe technique with low morbidity (55 of 640 patients [8.4%]), mortality (2 patients [0.3%]), and conversion to hand-assisted or open surgery (9 and 15 patients, respectively [3.7% combined]). Risk factors for perioperative complications in their study included conversion to open surgery, a diagnosis of pheochromocytoma, a tumor size of 6 cm or larger, and a rating of American Society of Anesthesiologists class 3 or 4.

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