Limits...
Laparoscopic adrenalectomy - ten-year experience.

Szydełko T, Lewandowski J, Panek W, Tupikowski K, Dembowski J, Zdrojowy R - Cent European J Urol (2012)

Bottom Line: There were three open conversions.The mean operative time was 158 minutes.The mean hospital stay was 5.5 days Blood transfusion was necessary in three patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Clinical Military Hospital, Wrocław, Poland.

ABSTRACT

Objectives: The objective of the study is to summarize the authors' 10-year experience with laparoscopic adrenalectomy and to analyze the intra- and postoperative complications of the procedure.

Material and methods: The records of 80 patients who had undergone laparoscopic adrenalectomy from January 2002 to January 2012 were reviewed retrospectively. There were 51 female and 29 male patients. The average age was 52. In 33 cases the right adrenal gland was affected, in 47 it was the left adrenal gland. Nineteen operations were performed with the retroperitoneal approach, in 61 a transperitoneal access was used. The average size of the tumor was 5 cm. The diagnosis was based on ultrasonography (USG) and computed tomography (CT). The biochemical tests were performed in all cases to assess hormonal activity of the tumor. Pheochromocytoma was diagnosed in 16 cases, Cushing syndrome in 3 cases, and Conn syndrome in 4 cases. All other tumors were hormonally inactive. Six patients were operated on because of adrenal metastases - from renal carcinoma in five cases and from lung carcinoma in one case.

Results: There were three open conversions. The mean operative time was 158 minutes. The mean hospital stay was 5.5 days Blood transfusion was necessary in three patients. Postoperative complications were observed in 11 patients (13.7%).

Conclusions: Laparoscopic adrenalectomy is a safe and effective procedure and should be considered the first - line treatment of benign adrenal masses. Our experience indicates that patients with adrenal metastases are suitable candidates for laparoscopic adrenalectomy, providing a skilled laparoscopic surgeon is involved in operation.

No MeSH data available.


Related in: MedlinePlus

Trocar placement for transperitoneal laparoscopic adrenalectomy: A – right side, B – left side.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3921778&req=5

Figure 0001: Trocar placement for transperitoneal laparoscopic adrenalectomy: A – right side, B – left side.

Mentions: The patient was placed in a left 45° flank position. A Hasson 1 cm minilaparotomy was used to create a pneumoperitoneum. The first 10 mm trocar was inserted below the umbilicus in the midline (for right-sided tumors) or at the edge of the rectus muscle (for left-sided tumors) (Fig. 1). The pneumoperitoneum was achieved in a standard manner. Three additional trocars (2x5 mm, 1x10 mm) were inserted under direct vision beneath the costal margin. If the operation was performed on the left side, the left colonic flexure was fully mobilized and the splenorenal ligament was divided to expose the adrenal gland in the retroperitoneal space. Then the renal vein and adrenal vein were exposed. Once freely dissected, the adrenal vein was clipped using titanium clips (TFX Medical Ltd., High Wycombe, UK) and transected. In order to mobilize the adrenal gland a Liga-Sure device (Tyco Healthcare UK Ltd., Gosport, UK) was used. After completing the resection, the specimen was entrapped in an Endocatch bag (Tyco Healthcare UK Ltd., Gosport, UK). A 5-mm closed suction drain was inserted through the port left by the lateral trocar and positioned in the left retroperitoneal space. The adrenal specimen was removed through the 10-mm trocar hole. If the procedure was performed on the right side, the most lateral trocar was used for a fan retractor, which was inserted for liver elevation. The antero-lateral wall of the vena cava was exposed and the right adrenal vein was localized, clipped, and divided. The adrenal gland was then dissected, entrapped in a specimen bag, and removed.


Laparoscopic adrenalectomy - ten-year experience.

Szydełko T, Lewandowski J, Panek W, Tupikowski K, Dembowski J, Zdrojowy R - Cent European J Urol (2012)

Trocar placement for transperitoneal laparoscopic adrenalectomy: A – right side, B – left side.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921778&req=5

Figure 0001: Trocar placement for transperitoneal laparoscopic adrenalectomy: A – right side, B – left side.
Mentions: The patient was placed in a left 45° flank position. A Hasson 1 cm minilaparotomy was used to create a pneumoperitoneum. The first 10 mm trocar was inserted below the umbilicus in the midline (for right-sided tumors) or at the edge of the rectus muscle (for left-sided tumors) (Fig. 1). The pneumoperitoneum was achieved in a standard manner. Three additional trocars (2x5 mm, 1x10 mm) were inserted under direct vision beneath the costal margin. If the operation was performed on the left side, the left colonic flexure was fully mobilized and the splenorenal ligament was divided to expose the adrenal gland in the retroperitoneal space. Then the renal vein and adrenal vein were exposed. Once freely dissected, the adrenal vein was clipped using titanium clips (TFX Medical Ltd., High Wycombe, UK) and transected. In order to mobilize the adrenal gland a Liga-Sure device (Tyco Healthcare UK Ltd., Gosport, UK) was used. After completing the resection, the specimen was entrapped in an Endocatch bag (Tyco Healthcare UK Ltd., Gosport, UK). A 5-mm closed suction drain was inserted through the port left by the lateral trocar and positioned in the left retroperitoneal space. The adrenal specimen was removed through the 10-mm trocar hole. If the procedure was performed on the right side, the most lateral trocar was used for a fan retractor, which was inserted for liver elevation. The antero-lateral wall of the vena cava was exposed and the right adrenal vein was localized, clipped, and divided. The adrenal gland was then dissected, entrapped in a specimen bag, and removed.

Bottom Line: There were three open conversions.The mean operative time was 158 minutes.The mean hospital stay was 5.5 days Blood transfusion was necessary in three patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Clinical Military Hospital, Wrocław, Poland.

ABSTRACT

Objectives: The objective of the study is to summarize the authors' 10-year experience with laparoscopic adrenalectomy and to analyze the intra- and postoperative complications of the procedure.

Material and methods: The records of 80 patients who had undergone laparoscopic adrenalectomy from January 2002 to January 2012 were reviewed retrospectively. There were 51 female and 29 male patients. The average age was 52. In 33 cases the right adrenal gland was affected, in 47 it was the left adrenal gland. Nineteen operations were performed with the retroperitoneal approach, in 61 a transperitoneal access was used. The average size of the tumor was 5 cm. The diagnosis was based on ultrasonography (USG) and computed tomography (CT). The biochemical tests were performed in all cases to assess hormonal activity of the tumor. Pheochromocytoma was diagnosed in 16 cases, Cushing syndrome in 3 cases, and Conn syndrome in 4 cases. All other tumors were hormonally inactive. Six patients were operated on because of adrenal metastases - from renal carcinoma in five cases and from lung carcinoma in one case.

Results: There were three open conversions. The mean operative time was 158 minutes. The mean hospital stay was 5.5 days Blood transfusion was necessary in three patients. Postoperative complications were observed in 11 patients (13.7%).

Conclusions: Laparoscopic adrenalectomy is a safe and effective procedure and should be considered the first - line treatment of benign adrenal masses. Our experience indicates that patients with adrenal metastases are suitable candidates for laparoscopic adrenalectomy, providing a skilled laparoscopic surgeon is involved in operation.

No MeSH data available.


Related in: MedlinePlus