Editorial comment

Laparoscopic adrenalectomy is now the accepted and preferred surgical approach for the management of most benign adrenal lesions less than 4 cm in size. Current management of suspected primary adrenocortical carcinoma remains open surgical intervention. Jeschke and colleagues present a compelling argument for the use of laparoscopic adrenal-sparing surgery in select patients diagnosed with Conn’s syndrome. Such candidates, despite having a normal contralateral adrenal gland, were found to have an aldosterone-secreting adrenal lesion of less than 3 cm, located away from the central portion with radiologic characteristics supporting a benign nature. Efforts were made to spare the main adrenal vein and vascular supply to the unaffected portion of the gland. Hemostatic techniques, including bipolar energy and fibrin glue, were used.

The reader should be cautioned that partial adrenalectomy, performed in a laparoscopic or open fashion, may be associated with significant complications, not least of which is postoperative hemorrhaging. Most urologists can vividly recall the unpleasant experience of returning to the operating room after a nephrectomy because of bleeding from the friable bed of an incompletely excised adrenal gland. Furthermore, it has been shown, in rare cases, that secondary foci of adenoma are pathologically detected in proximity of the nodule in a completely excised adrenal gland. This applies not only to aldosteronomas but also other adrenal histologic types. However, these authors and others1 provide long-term follow-up of more than 3 years showing no local tumor recurrence and excellent biochemical resolution of hyperaldosteronism.

The authors should be congratulated on pushing the frontiers of laparoscopic adrenal surgery forward in a well-controlled and sage fashion.