Laparoscopic adrenalectomy (LA) as the gold standard for small adrenal masses. However, the role of LA for large masses (typically considered size > 6cm) has been reported, but is less widely accepted. Current controversies include the appropriateness of LA for large or malignant tumors, paricularly when retrocaval dissection is anticipated. We present our contemporary experience with LA in this setting.

Three patients underwent laparoscopic adrenalectomy between 2006 and 2008, for adrenal lesions larger than 8 cm. Intraoperative data were collected retrospectively.

Mean tumor size was 10.6 cm (range 8.3-14 cm). Mean operative time was 180 minutes (range 120 to 300 minutes), and mean estimated blood loss was 183 ml. There were no intraoperative complicactions or convertions to open surgery. Surgical margins were negative in one patient with adrenocortical carcinoma. The video demonstrates complete suprarenal inferior vena caval mobilization in one case.

LA for adrenal masses larger than 8 cm is safe and feasible. Open surgical principles are replicated. The inferior vena cava can be mobilized, allowing safe escisión when retrocaval dissection is required.