Adrenalectomy for Familial Pheochromocytoma in the Laparoscopic Era

“…This has been driven by the potential of laparoscopic adrenalectomy to achieve the same goals as the standard open approach, while offering the patient distinct advantages with regard to the perioperative course [2,3].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative complications of laparoscopic adrenalectomy

2008

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A laparoscopic or retroperitoneoscopic access to the adrenal gland is the standard of care for adrenalectomy in most cases. Although in laparoscopic adrenalectomy the approach is minimally invasive, the procedure is challenging. This is reflected in the scope of possible complications. The surgeon must consider complications related to the anatomical topography of the adrenal gland, which typically encompasses the complications known from open surgery and complications related to the minimal invasive access. In this topic paper we will address the most frequently encountered complications of adrenalectomy: vascular injuries, injuries of the bowel, pleural tears, and injuries to the liver, spleen and pancreas. Fortunately, these complications occur rarely. However, many of these complications can have devastating consequences. Therefore, it's the surgeon's obligation to be aware of the possible complications he might encounter during laparoscopic adrenalectomy. This awareness is essential for their prevention and it helps the laparoscopic surgeon to identify complications intraoperatively. Intraoperative complications of laparoscopic adrenalectomy Conflict of interest None AbstractA laparoscopic or retroperitoneoscopic access to the adrenal gland is the standard of care for adrenalectomy in most cases. Although in laparoscopic adrenalectomy the approach is minimally invasive, the procedure is challenging. This is reflected in the scope of possible complications. The surgeon must consider complications related to the anatomical topography of the adrenal gland, which typically encompasses the complications known from open surgery and complications related to the minimal invasive access. In this topic paper we will address the most frequently encountered complications of adrenalectomy: vascular injuries, injuries of the bowel, pleural tears, and injuries to the liver, spleen and pancreas. Fortunately, these complications occur rarely. However, many of these complications can have devastating consequences. Therefore, it's the surgeon's obligation to be aware of the possible complications he might encounter during laparoscopic adrenalectomy. This awareness is essential for their prevention and it helps the laparoscopic surgeon to identify complications intraoperatively.2

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“…60% of malignant pheochromocytoma metabolises dopamine, secreting large amounts of methoxytyramine. When its concentration in plasma exceeds 3.0 nml/L, the risk of a cancer is three times as large as in the patients with correct levels of methoxytyramine [6,13,15,16].…”

Section: Szkolenie Podyplomowementioning

confidence: 99%

“…The cortex layer has not become thinner due to the expanding tumour, while ischaemic lesions are also not present (Fig. 1) [10,16,17].…”

Section: Szkolenie Podyplomowementioning

confidence: 99%

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Nieradykalne (oszczędzające) operacje guzów nadnerczy

Otto

Dzwonkowski²

2015

Endokrynologia Polska

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Currently, laparoscopic adrenalectomy is seen as more than just the preferred method, in fact as a routine procedure, always bearing in mind, however, the developed restraints on its usage. The size of the tumour, recurrent disease, and the existing invasive process all remain factors which determine the indications for operation. The situation is similar in cases of qualifying for sparing (non-radical) operations on adrenal glands. The basic challenge in terms of qualification, choice of technique and the range of operation of adrenal lesions remains: obtaining a reliable preoperative diagnosis, the localisation of lesions including their ectopic location, the evaluation of the imaging phenotype, as well as a proper pre-surgical preparation. Maintaining one third of properly vascularised adrenal mass allows one to avoid a substitutive therapy, with the possible necessity of its application in stressful situations. The first partial adrenalectomy has been conducted on a patient with a bilateral pheochromocytoma, in order to retain the glucocorticoid adrenal functions. The recommendations for its administration remain: hereditary pheochromocytoma of at least 2cm diameter, unilateral adenoma of at least 5cm diameter in Cushing's syndrome without any concomitant lesions in the oposite adrenal gland, and unilateral adenoma in Conn's syndrome. It seems that non-radical resection should always be considered for patients at risk of bilateral adrenalectomy in cases of concomitant lesions in both adrenals. StreszczenieObecnie adrenalektomia laparoskopowa traktowana jest już nie tylko jako metoda preferowana, lecz jako postępowanie rutynowe, jednak przy zachowaniu wypracowanych ograniczeń do jej zastosowania. Wielkość guza, zmiany nawrotowe, istniejący proces inwazyjny pozostają czynnikami warunkującymi wskazania do jej wykonania. Podobnie jest w kwalifikacji do operacji oszczędzających (nieradykalnych) na nadnerczach. Podstawową kwestią w kwalifikacji, doborze wyboru techniki i zakresu operacji zmian nadnerczowych pozostaje: pewność przedoperacyjnego rozpoznania, lokalizacja zmian łącznie z ekotopowym ich położeniem, ocena obrazowego fenotypu jak również właściwe przygotowanie przedoperacyjne. Zachowanie 1/3 dobrze unaczynionej masy nadnerczy pozwala na uniknięcie terapii substytucyjnej z możliwą koniecznością jej zastosowania w sytuacjach stresowych. Pierwszą częściową adrenalektomię wykonano u chorego z obustronnym guzem chromochłonnym dla utrzymania czynności glikokortykostroidowej nadnerczy. Wskazaniami do jej wykonania pozostają: guz chromochłonny uwarunkowany dziedzicznie o średnicy 2 cm, jednostronny gruczolak o średnicy ≥ 5 cm w zespole Cushinga bez współistniejących zmian w drugim nadnerczu, jednostronny gruczolak w zespole Conna. Wydaje się, że nieradykalna resekcja powinna być zawsze rozważana u chorych zagrożonych obustronną adrenalektomią w przypadkach współistnienia zmian w obu nadnerczach.

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Adrenalectomy for Familial Pheochromocytoma in the Laparoscopic Era

Cited by 80 publications

References 55 publications

Laparoscopic Adrenalectomy: Lessons Learned from 306 Cases

Laparoscopic Adrenalectomy: Lessons Learned from 306 Cases

Intraoperative complications of laparoscopic adrenalectomy

Nieradykalne (oszczędzające) operacje guzów nadnerczy

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