#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

120 Laparoscopic Adrenalectomies with a Harmonic Scalpel


Authors: M. Kasalický;  M. Kršek *;  T. Zelinka *;  V. Hána *;  J. Widimský *
Authors‘ workplace: Chirurgická klinika 2. LF UK a ÚVN v Praze, přednosta: prof. MUDr. M. Ryska, CSc. ;  III. interní klinika l. LF UK a VFN v Praze, přednosta: prof. MUDr. Š. Svačina, DrSc., MBA *
Published in: Rozhl. Chir., 2009, roč. 88, č. 8, s. 439-443.
Category: Monothematic special - Original

Overview

Background:
Presently the laparoscopic adrenalectomy (LA) becomes most popular since 1992 when it was performed for the first time by laparoscopic method by Gagner. Typical indication for LA is the aldosteron-secreting adenoma, Cushing’s syndrome, feochromocytoma or scarcity tumors such as adrenal cyst or myelolipomas.

Aim:
The evaluation of the laparoscopic adrenalectomy as safe method for adrenals tumouťs extirpation to the sizes 10 cm.

Methods:
LA is provided with transperitoneal lateral approach most frequently then in back side position. Retroperitoneal approach is used less commonly.

Results:
Since 2006, firstly at the lst Surgical department of lst Medical School of Charles University and General Faculty Hospital and lastly at the Surgical department 2nd Medical School of Charles University and Central Military Hospital, has been performed on the whole 120 LA in 114 patients. The bilateral LA was performed in 6 patients. The conversion from the laparoscopic to open adrenalectomy was necessary by reason of the king size of the tumor (13/14 cm) in two cases. The lateral position and transperitoneal approach was used in all cases. The harmonie scalpel was ušed with advantage. Average length of the operation was 82 minutes (40–154 min), respective 180 minutes (130–270 min) in the case of the bilateral LA. The median size of the adrenal tumor was 4.9 cm (1.5–12.5 cm) with average weight 44 g (18–421 g). All of the patients after LA were monitored for 24 hours in the Intensive care units. The average time of the hospitalization was 3.7 days (2–6 days).

Conclusion:
Laparoscopic adrenalectomy presently becomes as the „gold standard“ for the treatment of adrenal tumors to the size 10 cm namely and in the event of malignancy. The harmonie scalpel is useful and sparing advice for the LA.

Key words:
laparoscopic adrenalectomy – transabdominal approach – adrenal tumors –harmonic scalpel


Sources

1. Kasalický, M. Tubulizace žaludku chirurgická léčba obezity. Triton 2007; Praha.

2. Kasalický, M., Michalský, D., Housová, J., Haluzík, M. Laparoskopická tubulizace žaludku – sleeve gastrectomy – další možnost bariatrické restrikce příjmu stravy u morbidně obézních jedinců. Rozhl. Chir., 2007; 86(11): 601–606.

3. Gagner, M., Lacroix, A., Bolte, E. Laparoscopic adrenalectomy in Cushing‘s syndrome and pheochromocytoma. N. Eng. J. Med., 1992; 327: 1033.

4. Gagner, M., Lacroix, A., Bolte, E. et al. Laparoscopic adrenalectomy. The importace of a flank approach in the lateral decubitus position. Surg. Endosc., 1994; 8: 135–138.

5. Toniato, A., Boschin I., Bernate, P., et al. Laparoscopic adrenalectomy for pheochromocytoma: is it really more difficult? Surg. Endosc., 2007; 21: 1323–1326.

6. National Institutes of Health NIH state-of-the-science statement on management of clinically inapparent adrenal mass („incidentaloma“). NIH Consensus Satatement Sci Statements, 2002; 19: 1–25.

7. Noca, D., Aggarwal, R., Mathieu, A., et al. Laparoscopic surgery and corticoadreanalomas. Endosc. Surg., 2007; 21: 1373–1376.

8. Mansmann, G., Lau, J., Balk, E., et al. The clinically inapparent adrenal mass: update in diagnosis and management. Endocrine Reviews, 2004; 25(2): 309–340.

9. Kršek, M. Incidentalomy nadledvin. Vnitřní lékařství, 2007; 53(7–8): 821–825.

10. Widimský, J. Incidentalomy nadledvin/zvětšení nadledvin: stručný přehled. Arteriální hypertenze – současné klinické trendy. Triton, 2008, s. 41–45.

11. Ramacciato, G., Mercantini, P., Nelotri, G., et al. Is laparoscopic adrenalectomy safe and effective for adrenal masses larger than 7 cm. Endosc. Surg., 2008; 22: 516–521.

12. Cestari, A., Buffi, N., Centemero, A., et al. Transperitoneal laparoscopic adrenalectomy: the choice. Eu. Urol., 2007; 6: 90(P15).

13. Porpiglia, F., Fiori, C., Tarabuzzi, R., et al. Is laparoscopic adrenalectomy feasible for adrenocortical carcinoma or metastasi? BJU Int., 2004; 94: 1026–1029.

14. Gagner, M. Laparoscopic adrenalectomy. Surg. Clin. North Am., 1996; 76: 523–537.

15. Kim, H. H., Kim, G. H., Sung, G. T. Laparoscopic adrenalectomy for pheochromocytoma. Eu. Urol., 2004; 45: 226–232.

16. Stugeron, C., Kebebew, E. Laparoscopic adrenalectomy for malignancy. Surg. Clin. North Am., 2004; 84: 755–774.

17. Lombardi, C. P., Raffaeli, M., De Crea, C., et al. Role of laparoscopy in the management of adrenal maignancies. J. Surg. Oncol., 2006, 94: 128–131.

18. Lazoche, E., Guerrieri, M., Crosta, F., et al. Perioperative results of 214 laparoscopic adrenalectomies by anterior transperitoneal approach. Endosc. Surg., 2008; 22: 522–526.

19. Gumbs, A. A., Gagner, M. Laparoscopic adrenalectomy. Best Pract. Res. Clin. Endocrinol. Metab., 2006; 20(3): 483–499.

Labels
Surgery Orthopaedics Trauma surgery

Article was published in

Perspectives in Surgery

Issue 8

2009 Issue 8

Most read in this issue
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#