Laparoscopic Adrenalectomy
Authors:
P. Stránský 1; M. Hora 1; V. Eret 1; J. Klečka 1; T. Ürge 1; H. Grégrová 2; E. Dvořáková 3; O. Hes 4; Z. Chudáček 5; B. Kreuzberg 6
Authors‘ workplace:
Urologická klinika LF UK a FN Plzeň
1; II. interní klinika LF UK a FN Plzeň
2; I. interní klinika LF UK a FN Plzeň
3; Šiklův patologicko-anatomický ústav LF UK a FN Plzeň
4; Radiodiagnostické oddělení FN Plzeň
5; Radiodiagnostická klinika LF UK a FN Plzeň
Práce byla podpořena výzkumným záměrem MSM 0021620819.
6
Published in:
Rozhl. Chir., 2009, roč. 88, č. 9, s. 514-520.
Category:
Monothematic special - Original
Overview
Objective:
Laparoscopy has become the gold standard for the treatment of adrenal tumours in urology. We evaluate our experience with laparoscopic adrenalectomy (LA) in this work.
Material, methods: We performed 38 LA between 2003–2008. We use computer tomography (CT) and magnetic resonance imaging (MRI) for the initial evaluation. Indication for proceduře is made in cooperation with endocrinologist. We use transperitoneal approach with 3 or 5 ports.
Results:
Mean age was 57.7 ± 11.7 year (range 32–74.9 year). Nine LA were made in men (24%), in women 29 (76%). Sixteen tumours (42%) were hormonal active (7 pheochromocytoma, 6 primary hyperaldosteronism, 3 peripheral hypercortisolism). Twenty-two tumours were without hormonal activity. Mean tumour size was 4.1 ± 2 cm (range 1–10.l cm), mean operation time was 89 ± 38 minutes (range 32–220 minutes), mean blood loss was 33 ± 75 ml (range 0–400 ml), mean hospitalization time was 6.1 days (range 3–12 days). There were histologically 15 cortical adenomas, 5 nodular cortical hyperplasia, 1 calcificated hematoma, 3 cysts, 2 potentional malignant tumours on interface between adenoma and carcinoma, 1 cortical carcinoma and 7 pheochromocytoma. We found 3 metastases of renal carcinoma in adrenal gland and one metastasis mesenchymal chondrosarcoma too. Transperitoneal approach was chosen in 20 patients (53%) after previous abdominal operation (open cholecystectomy, appendectomy, transperitoneal nephrectomy, aortofemoral bypass). Complications were in 3 cases from 38 (8%). It was one perforation of diaphragm, which was resolve with laparoscopic suture, one postoperative delirium with fudge and agitation, one abscess in wound after extraction of specimen. We have got any conversion in our collection. The body mass index was higher than 38 in 3 patients.
Conclusion:
LA is a quick and safe procedure with minimal morbidity and mortality. This procedure requires very experienced surgeon. Patients profit especially from miniinvasivity and short convalescence. Especially benign tumours of smaller size (by 8 cm) are indicated, extensive and especially malignant tumours remain a domain of open approach. Previous operations in abdominal cavity do not have to be a contraindication for LA and operation is possible in patients with monster obesity.
Key words:
adrenalectomy – laparoscopy – adrenal gland – adrenal tumour
Sources
1. Gagner, M., Lacroix, A., Bolte, E. Laparoscopic adrenalectomy in Cushing‘s syndrome and pheochromocytoma. N. Engl. J. Med., 1992; 327: 1033–1039.
2. El-Hakim, A., Lee, B. R. Laparoscopic adrenalectomy: when and how. Cont. Urol., 2003, 15,4: 56–66
3. Študent, V. Laparoskopická adrenalektomie. Habilitační práce. Univerzita Palackého v Olomouci. 2004: 146 s.
4. Šafařík, L., Novák, K., Závada, J., Bízová, Š., Stolz, J., Sedláček, J., Dvořáček, J., Vraný, M. Výhody a rizika laparoskopických operací u dospělých pacientů v urologii. Rozhl. Chir., 2003, 82, 12: 645–651.
5. Salomon, L., Soulié, M. Experience with retroperitoneal laparoscopic adrenalectomy in 115 procedures. J. Urol., 2001, 166: 38–41.
6. Lin, Y., Li, L., Zhu, J., Qiang, W., Makiyama, K., Kubota, Y. Experience ofretroperitoneoscopic adrenalectomy in 195 patients with primary aldosteronism. Int. J. Urol., 2007, 14: 910–913.
7. Zacharias, M., Haese, A., Jurczok, A., Stolzenburg, J., Fornara, P. Transperitoneal Laparoscopic Adrenalectomy: Outline of the preoperative management, surgical approach and outcome. Eur. Urol., 2006, 49: 448–459.
8. Vraný, M., Šafařík, L. Laparoskopická adrenalektomie. In: Dvořáček, J., Babouk, M. Onkourologie. Galén, 2005: 9–24.
9. Eret, V., Hora, M., Klečka, J., Stránský, P., Grégrová, H. Laparoskopická adrenalektomie. Plzeň. Lék. Sborn., 72, 2006: 109–116.
10. Hamilton, B. D. Transperitoneal laparoscopic adrenalectomy. Urol. Clin. North Am., 28, 2001: 61–69.
11. Kuczyk, M., Wegener, G., Jonas, U. The terapeutic value of adrenalectomy in cases of solitary metastatic spread originating from primary renal cell cancer. Eur. Urol., 2005, 48: 252–275.
12. Maccabee, D. L., Jones, A., Moreis, J. Transition from open to laparoscopic adrenalectomy. Surg. Endosc., 2003, 17: 1566–1569.
13. Šafařík, L., Vraný, M., Widimský, J., Dvořáček, J., Novák, K., Dušková, J. Laparoskopická transperitoneální adrenalektomie u hormonálně aktivních nádorů nadledvin. Rozhl. Chir., 2002, 81, 3: 127–132.
14. Sung, G. T., Gill, I. S., Hobart, M. M. Prospective randomized comparison of transperitoneal vs. retroperitoneal laparoscopic adrenalectomy. J. Endourol., 13,1999: 86.
15. Rubinstein, M., Gill, I. S., Aron, M., Kilciler, M. Prospective, randomized comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy. J. Urol., 2005, 174: 442–445.
16. Suyama, K., Beppu, T., Isiko, T., Sugiyama, S., Doi, K., Masuda, T., Ikeda, O., Takamori, H., Tsuji, R., Kanemitsu, K., Egami, H., Baba, H., Saisyoji, T. Hand-assisted laparoscopic adrenalectomy to a solitary adrenal metastasis from lung cancer. Gan To Kagaku Ryoho, 2005; 11, 32: 1839–1841.
17. Sidhu, S., Campbell, P., Carmalt, H., Magarey, C. Hand-assisted laparoscopic adrenalectomy: an alternative minimal invasive surgical technique for the adrenal gland. A. N. Z. J. Surg., 2003, 73: 964–965.
18. Bennett, I. C., Ray, M. Hand-assisted laparoscopic adrenalectomy: An alternative minimal invasive surgical technique for the adrenal gland. A. N. Z. J. Surg., 2002; 72: 801–805.
19. Matsumoto, K., Egawa, S., Satih, T., Okuno, N., Kaseta, S., Bara, S. Thoracoscopic transdiaphragmatic adrenalectomy for isolated locally recurrent adrenal carcinoma. Int. J. Urol., 2005, 12: 1055–1057.
20. Gill, I. S., Meraney, M. A., Thomas, J., Sung, T. G., Novick, A. C. Thoracoscopic transdiaphragmatic adrenalectomy – the initial experience. J. Urol., 2001, 165: 1875–1881.
21. Gill, I. S. Needlescopic urology. Current status. Urol. Clin. North Am., 2001, 28: 71–83.
22. Mamaza, J., Schlachta, C. M., Seshadri, P. A., Cadeddu, M. O., Poulin, E. C. Needlescopic surgery. A logica evolution from conventional laparoscopic surgery. Surg. Endosc., 2001, 15: 1208–1215.
23. Liao, C. H., Lai, M. K., Li, H. Y., Chen, S. C., Chueh, S. C. Laparoscopic Adrenalectomy Using Needlescopic Instruments for Adrenal Tumors Less Than 5 cm in 112 Cases. European Urology, 54, 2008: 640–646.
24. Horgan, S., Vanuno, D. Robotics in laparoscopic surgery. J. Laparoendosc. Adv. Surg. Tech., A 2001; 11: 415–419.
25 Zafar, S. S., Ronney Abaza, R. Robot-Assisted Laparoscopic Adrenalectomy for Adrenocortical Carcinoma: Initial Report and Review of the Literature. J. Endourol., 22, 5, 2008: 910–913.
26. Strebel, R. T., Müntener, M., Sulser, T. Intraoperative complications of laparoscopic adrenalectomy. World J. Urol., 2008, 26: 555–560.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2009 Issue 9
Most read in this issue
- Compressive Syndromes of the Subscapular Nerve – Experience with Surgery
- Fast Track in Intestinal Surgery; Current Review
- Foreign Bodies – Uncommon Causes of GIT Injuries
- Laparoscopic Adrenalectomy