Laparoscopic radiofrequency thermal ablation of adrenal tumors: technical details.

BACKGROUND: Despite reports of percutaneous radiofrequency ablation (RFA), laparoscopic ablative techniques have not been described to treat adrenal tumors. The aim of this study is to describe patient selection criteria and the technique for laparoscopic adrenal RFA.

METHODS: Four patients underwent laparoscopic RFA of adrenal tumors under general anesthesia for adrenal tumors. Procedures were carried out under the guidance of laparoscopic ultrasound. Medical records of these patients were reviewed retrospectively. Ablations were carried out using Angiodynamics Model 30 (n=1) 2 cm and Model 90 (n=3) 5-cm ablation catheters.

RESULTS: Pathology included lung metastasis in 2 patients, and renal cell cancer metastasis and cortical adenoma in 1 patient each. Metastatic lesions were not resectable owing to the concomitant liver metastasis in 2 patients and because of local invasion in the third patient. The first 2 patients also underwent concomitant laparoscopic liver RFA. In the fourth patient with adrenocortical adenoma, ablation was carried out owing to the cardiopulmonary instability of the patient during attempted laparoscopic adrenalectomy. Two patients had right and 2 patients had left sided lesions. Despite normal catecholamine levels preoperatively, 2 patients had a transient hypertensive period during the ablation possibly owing to the release of catecholamines from the normal adrenal medulla. The procedures were carried out using a lateral transabdominal (n=4) or posterior (n=1) approaches. There were no perioperative complications or mortality. The ablated lesions showed a nonenhancing hypodense appearance in postoperative CT scans. Patients were followed up for a mean 19 months. One patient died at 3 months from cardiac causes, and 1 other patient died at 51 months.

CONCLUSIONS: To our knowledge, this is the first report of laparoscopic adrenal RFA. Laparoscopic RFA is an option for patients with unresectable adrenal tumors owing to the extent of disease or comorbidities. The procedure can be carried out safely using any standard laparoscopic adrenalectomy approaches.