Laparoscopic adrenalectomy in asymptomatic pheochromocytoma.

A patient with asymptomatic pheochromocytoma associated with catecholamine hypersecretion but no hypertension was treated by right laparoscopic adrenalectomy. The 63-year-old male patient was referred to us for treatment of an incidentaloma. The diameter of the adrenal tumor was 50 mm, and the peripheral blood nonrepinephrine level was 1.12 ng/ml (normal level, 0.4 ng/ml). Blood pressure was normal. A flexible electron laparoscope was used for open laparoscopy, and four trocars were inserted. The retroperitoneum was incised to the right of the inferior vena cava, and the tumor was excised. During the operation, blood pressure rose transiently, and a blocker and nitroglycerin were administered. The tumor bled extremely easily. The duration of surgery was 3 hours and 20 minutes, and blood loss was 210 ml. The excised tumor was 55 mm in diameter. The patients's postoperative course was uneventful. If the size of asymptomatic pheochromocytoma is not large, and blood pressure and cardiac function are stable, laparoscopic adrenalectomy is indicated for this type of tumor as long as it is performed by experienced surgeons.