The first laparoscopic adrenalectomy (LA) was described since 1992 by Gagner et al. Due to the challenges in the management of adrenal tumor especially secreting tumor that required a multi-disciplinary team from preoperative work up, intra operative management and post operative care, Laparoscopic adrenalectomy in Cambodia has just becoming more practical and successful recently. This minimally invasive surgical approach has gradually replaced the open adrenalectomy in the management of small and medium-sized adrenal lesions. The advantages of LA include shorter hospital stays, decreased postoperative pain, improved recovery times, and better cosmetic results. In addition, difficulty with open surgical exposure and the small size of the adrenal gland make this organ particularly amenable to a minimally invasive technique.

From 2010 to 2024, data and the challenges we faced in each of 21 patients that had underwent laparoscopic Adrenalectomy for benign and malignant Adrenal diseases were retrospectively evaluated. Demographic characteristics, mains symptoms, hormonal work up, imaging studies, surgical information, surgical technique, and approach as well as complications were analyzed. The histological diagnosis was reviewed in the follow up.

21 cases of laparoscopic adrenalectomy out of 30 cases of the overall adrenalectomy performed in the period of 14 years, including 7cases of Conn Adenoma, 6 cases of Pheochromocytoma, 3 cases of Adenoma, 1 cases of Cushing, 2 cases of Adrenocortical Carcinoma, 1 case of Adrenal cystic Lymphangioma and 1 case of Tuberculosis cystic. All were done transperitoneal and patient were placed lateral decubitus position 45% outward to kidney side with support under patient ribs. Out of the 21 cases, 4.76% equal to 1 case were converted into open surgery because of uncontrollable bleeding. No Blood transfusion needed in all the cases. 19% of the surgeries were performed with three trocars, 81% with four trocars. The average bleeding per procedure is 150 cc. Surgical time used during each surgery is 140 min, on average. No complication intra operatively or post operatively were recorded. Mean length of hospital stay was 3.7 days (range 3–6 days).

Laparoscopic adrenalectomy is a safe and effective technique for the surgical removal of adrenal masses. As adrenal tumor is quite rare, so Cambodian surgeon especially urologist which considered this type of tumor a subspecialties, are not well train for its proper management. It certainly needs an army of expert to work together such as Endocrinologists, Radiologists, Urologists, Anesthesiologists and Intensivists just to ensure the safety of an adrenal tumor patient. Just recently in addition to the MDT work and our hard work, this minimally invasive approach provides clear advantages over open resection. With careful patient selection, hormonal work up, and careful surgical technique, and carefully monitor post operatively, successful outcomes should be expected.