Purpose: Laparoscopic adrenalectomy (LA) is controversial for large, potentially malignant tumors. We report a series of LA or hand-assisted LA for large (>5 cm) adrenal tumors.

Materials and Methods: Among 210 LAs performed in 6 yr, 39 patients had potentially malignant tumors >5 cm in diameter. Their perioperative and follow-up data were retrospectively analyzed.

Results: All 39 patients had successful LAs without peri-operative mortality, conversion to open surgery, or capsular disruption during dissection. The mean tumor size was 6.2 cm (range: 5-12 cm), operative time 207 min (115-315 min), and blood loss 75 ml (minimal-1400 ml). Complications included 1 intraoperative diaphragmatic perforation, 3 mild wound infections, and 1 pneumonia. Preoperatively, there were 27 non-functioning tumors, 7 pheochromocytomas, 3 cortisol-secreting tumors, and 2 virilizing tumors. Final pathology revealed 8 malignant (4 adrenocortical carcinomas [ACCs], and 4 metastatic carcinomas) and 31 benign tumors (14 cortical adenomas, 8 pheochromocytomas, 6 myelolipomas, and 3 ganglioneuromas). Median follow-up was 39 months. Four patients (2 ACCs, 1 metastatic hepatoma, and 1 lymphoma) died 24, 10, 9, and 3 months after surgery, respectively. A hand-assisted device was used in 10 patients. Only the tumor size was larger and length of postoperative hospital stay was longer for those in the hand-assisted group.

Conclusions: LA is a reasonable option for selected large adrenal tumors when complete resection is technically feasible and there is no evidence of local invasion. Hand-assisted LA is a good alternative to open conversion if a difficult dissection is encountered intra-operatively.