Initial experience of hand-assisted laparoscopic adrenalectomy (HALA)

Purpose: Laparoscopic adrenalectomy has been a standard method for adrenal gland tumors. On the other hand, hand-assisted laparoscopic adrenalectomy is an operative method which enables operator to use a hand to facilitate dissection and retraction. The aim of this study was to report initial experience of hand-assisted laparoscopic adrenalectomy and to evaluate potentialities for surgical application. Methods: Seven patients who underwent hand-assisted adrenalectomy from September 2010 to July 2013 were enrolled. Clinicopathological characteristics, intraoperative hemodynamic status, and parameters associated with postoperative recovery were reviewed. Surgical indications for hand-assisted laparoscopic adrenalectomy were right side adrenal tumors larger than 4 cm on preoperative computed tomography (CT) scan. Mean age was 36.9 years (range, 23 to 51 years) and there were 3 men and 4 women. Results: The mean size of adrenal tumor was 6.1±2.4 cm. Operation time was 119.4±29.7 minutes in average and mean blood loss was 142.9±109.7 mL. There were 4 patients with pheochromocytoma, one patient for each adrenocortical neoplasm, paraganglioma and lymphoma. Intraoperative hypertensive crisis were observed in 2 patients with pheochromocytoma and there was no intraoperative tachycardia crisis. Patients had first oral intake at 1.4±0.8 days in average and mean postoperative hospital stay was 3.4±1.3 days. There was no postoperative complication and mortality. The median follow-up was 12 months and there was no case with evidence of recurrence during the periods. Conclusion: In our initial experience, hand-assisted laparoscopic adrenalectomy was performed safely and effectively. Hand-assisted laparoscopic adrenalectomy might be an alternative to laparoscopic adrenalectomy for moderate sized right side adrenal tumors.