Limits...
Laparoscopic adrenalectomy: An update.

Al-Zahrani HM - Arab J Urol (2012)

Bottom Line: The introduction of laparoscopy has resulted in more adrenal lesions being removed, especially incidental lesions smaller than the 5-6 cm that was previously the indication for surgical excision.The transperitoneal and retroperitoneal approaches are currently widely practised, with minor differences in the outcome.LA is the standard procedure for most adrenal lesions of appropriate size and no signs of surrounding tissue invasion, giving an excellent outcome.

View Article: PubMed Central - PubMed

Affiliation: King Faisal Specialist Hospital, Riyadh, Saudi Arabia.

ABSTRACT

Objective: To review the current role and outcome of laparoscopic adrenalectomy (LA) in the management of adrenal tumours.

Methods: A Medline search using the keywords (adrenalectomy, laparoscopy, adrenal masses/tumours) was done for reports published between 1990 and 2011. Key articles were used to find more relevant references on the evaluation and laparoscopic management of adrenal masses.

Results: The hormonal evaluation is not standardised, but initial screening tests are recommended and followed with confirmatory ones when positive, equivocal or the clinical presentation suggest adrenal hyperfunction. The imaging studies had, and continued to, advance, especially computed tomography (CT), magnetic resonance imaging and positron-emission tomography/CT. These advances have increased the accuracy of the diagnosis of adrenal masses, with a reported high sensitivity and specificity of 95-100%. The introduction of laparoscopy has resulted in more adrenal lesions being removed, especially incidental lesions smaller than the 5-6 cm that was previously the indication for surgical excision. The technique has developed and larger lesions of >6 cm are now considered for LA in the proper setting. The transperitoneal and retroperitoneal approaches are currently widely practised, with minor differences in the outcome. The reported outcome, although mostly retrospective, is excellent and with fewer complications. The role of LA for adrenal malignancy should be considered cautiously. Preoperative imaging signs of invasion into surrounding structures should be considered a contraindication for LA.

Conclusion: LA is the standard procedure for most adrenal lesions of appropriate size and no signs of surrounding tissue invasion, giving an excellent outcome.

No MeSH data available.


Related in: MedlinePlus

Retroperitoneal view for right LA.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4442880&req=5

f0030: Retroperitoneal view for right LA.

Mentions: On the right side, the landmarks to find are the psoas muscle and the right ureter. By lifting the kidney upwards the IVC and gonadal vein are usually identified. The right ureter can be used as a guide to find the right renal hilum. Dissection is carried out cranially to further expose the upper IVC to find the right adrenal vein (Fig. 6). In patients with excessive perirenal fat, it is helpful to open Gerota’s fascia and expose the upper pole of the right kidney. Careful dissection is done on the lateral aspect of the IVC until the adrenal vein is identified, clipped and divided or controlled with LigaSure. Inferior, medial and posterior dissection is done to free the mass from upper pole of the kidney, IVC and diaphragm, taking care to control additional veins as needed. The superior and lateral attachments are then freed and the tumour is placed in an endobag. The field is inspected for haemostasis and the specimen is removed by enlarging the initial camera port while the camera is placed in the 10 mm posterior working port.


Laparoscopic adrenalectomy: An update.

Al-Zahrani HM - Arab J Urol (2012)

Retroperitoneal view for right LA.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4442880&req=5

f0030: Retroperitoneal view for right LA.
Mentions: On the right side, the landmarks to find are the psoas muscle and the right ureter. By lifting the kidney upwards the IVC and gonadal vein are usually identified. The right ureter can be used as a guide to find the right renal hilum. Dissection is carried out cranially to further expose the upper IVC to find the right adrenal vein (Fig. 6). In patients with excessive perirenal fat, it is helpful to open Gerota’s fascia and expose the upper pole of the right kidney. Careful dissection is done on the lateral aspect of the IVC until the adrenal vein is identified, clipped and divided or controlled with LigaSure. Inferior, medial and posterior dissection is done to free the mass from upper pole of the kidney, IVC and diaphragm, taking care to control additional veins as needed. The superior and lateral attachments are then freed and the tumour is placed in an endobag. The field is inspected for haemostasis and the specimen is removed by enlarging the initial camera port while the camera is placed in the 10 mm posterior working port.

Bottom Line: The introduction of laparoscopy has resulted in more adrenal lesions being removed, especially incidental lesions smaller than the 5-6 cm that was previously the indication for surgical excision.The transperitoneal and retroperitoneal approaches are currently widely practised, with minor differences in the outcome.LA is the standard procedure for most adrenal lesions of appropriate size and no signs of surrounding tissue invasion, giving an excellent outcome.

View Article: PubMed Central - PubMed

Affiliation: King Faisal Specialist Hospital, Riyadh, Saudi Arabia.

ABSTRACT

Objective: To review the current role and outcome of laparoscopic adrenalectomy (LA) in the management of adrenal tumours.

Methods: A Medline search using the keywords (adrenalectomy, laparoscopy, adrenal masses/tumours) was done for reports published between 1990 and 2011. Key articles were used to find more relevant references on the evaluation and laparoscopic management of adrenal masses.

Results: The hormonal evaluation is not standardised, but initial screening tests are recommended and followed with confirmatory ones when positive, equivocal or the clinical presentation suggest adrenal hyperfunction. The imaging studies had, and continued to, advance, especially computed tomography (CT), magnetic resonance imaging and positron-emission tomography/CT. These advances have increased the accuracy of the diagnosis of adrenal masses, with a reported high sensitivity and specificity of 95-100%. The introduction of laparoscopy has resulted in more adrenal lesions being removed, especially incidental lesions smaller than the 5-6 cm that was previously the indication for surgical excision. The technique has developed and larger lesions of >6 cm are now considered for LA in the proper setting. The transperitoneal and retroperitoneal approaches are currently widely practised, with minor differences in the outcome. The reported outcome, although mostly retrospective, is excellent and with fewer complications. The role of LA for adrenal malignancy should be considered cautiously. Preoperative imaging signs of invasion into surrounding structures should be considered a contraindication for LA.

Conclusion: LA is the standard procedure for most adrenal lesions of appropriate size and no signs of surrounding tissue invasion, giving an excellent outcome.

No MeSH data available.


Related in: MedlinePlus