Laparoscopic Management of Potentially Malignant or Complex Adrenal Cysts Abiding by the Principles of Surgical Oncology

Background and Purpose: Few articles have illustrated minimally invasive management of potentially malignant adrenal cysts. The aim of this study was to evaluate the feasibility of laparoscopic adrenalectomy for potentially malignant adrenal cysts Patients and Methods: Eight patients with potentially malignant or complex cysts were treated by laparoscopic adrenalectomy in the past 10 years at our institution. The operative techniques strictly abided by the principles of surgical oncology. The entire adrenal gland, including the cyst, was excised en bloc via a lateral transperitoneal laparoscopic approach and moved into a LapSac (R) bag. After protecting the exterior abdominal surface, we pulled the LapSac's opening out of the periumbilical wound and opened the cyst wall to siphon all the fluid content with a sucker tip dipped into the cyst cavity. Then the remaining cyst components and the adrenal gland were removed with the bag. Results: All of the laparoscopic operations were successful without intraoperative or postoperative morbidity, open conversion, or mortality. Mean operative time was 135 minutes with minimal blood loss. Mean hospital stay was 3.4 days. Histopathologic examinations revealed five hemorrhagic pseudocysts, two endothelial cysts, and a cystic pheochromocytoma. There was involvement of periadrenal adipose tissues by the chromium-staining tumor cells in the cystic pheochromocytoma, and malignancy could not be excluded. At a mean follow-up of 40 months, all patients were asymptomatic and had no radiographic evidence of recurrence or dissemination. Conclusions: To our knowledge, this report represents the largest series of laparoscopic excisions for complex adrenal cysts. This technique is safe and feasible, while maintaining the benefits of minimal invasiveness.