Laparoscopic Adrenal Compartment Resection for Paediatric Adrenal Neoplasms: Surgical Technique and Single-Centre Experience.

OBJECTIVE

Laparoscopic adrenalectomy is standard in adults, but evidence in children remains limited. This study describes a standardised transperitoneal laparoscopic adrenal compartment resection technique and evaluates its safety, reproducibility and outcomes.

METHODS

All paediatric patients undergoing transperitoneal laparoscopic adrenalectomy at our centre from 2022 to 2025 were retrospectively reviewed. Clinical and intraoperative data were collected. Procedures were standardised with lateral positioning, three to four subcostal trocars and dissection along embryological avascular planes, avoiding direct gland manipulation.

RESULTS

Eleven patients were included, median age 4.3 years. Nine had neuroblastic tumours and two had adrenocortical tumours. Mean tumour volume was 197 cm3, mean diameter 39.7 mm. Conversion to open surgery occurred in two IDRF-positive neuroblastomas (18%) due to bleeding and adherence to renal vein. Mean operative time was 157 min; mean hospitalisation 5.2 days. No postoperative complications occurred. All patients had complete macroscopic resection; four (36.4%) showed microscopic margin infiltration. No local recurrences; one high-risk neuroblastoma progressed with metastases.

CONCLUSIONS

Standardised laparoscopic adrenal compartment resection is safe and reproducible in selected paediatric patients, feasible even in IDRF-positive tumours. Exclusive dissection along avascular embryological planes ensures oncological radicality, maintaining minimally invasive benefits.