Intraoperative complications of laparoscopic adrenalectomy

Abstract

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

Komplikationen in der Nebennierenchirurgie

“…In diesem Zusammenhang ist das Wissen über mögliche Gefäßvariationen, die in der Literatur mit 10 bis 13 % angegeben werden, zur Prävention von intraoperativen Blutungskomplikationen von relevanter Bedeutung (Schloten 2013;Strebel 2008).…”

“…(Lenders 2014;Schloten 2011). Bei fast 60 % der so behandelten Patienten kann eine lebenslange Steroidabhän-gigkeit vermieden werden (Castinetti 2013 Die Inzidenz für Blutungskomplikationen wird in der Literatur mit 0,7 bis 5,4 % angegeben, wobei schwere Komplikationen selten sind (Strebel 2008).…”

“…Zur Beherrschung kann zunächst kurzfristig der abdominelle Druck auf 25 mmHg gesteigert werden und bei kleinen Blutungen lokal Druck mittels Stieltupfer ausgeübt, sowie Hämostyptika verwendet werden (Strebel 2008).…”

Commentary on the article “Diaphragm perforation during laparoscopic left adrenalectomy” of Stanisław Głuszek, Monika Kozłowska

“…There are no relevant differences in occurrence of neurological, gastrointestinal and thromboembolic complications. Morbidity is about 0.3% in AL and 0.9% in AC [4,5]. In our material (over 500 laparoscopic adrenalectomies) intraoperative complications occurred in 0.7% of all cases, postoperative in 2.6% and conversions in 2.8%, morbidity: 0.02% [6][7][8][9].…”

NOTES new frontier: Natural orifice approach to retroperitoneal disease

“…Trocar site complications (hematoma, infections, cell seeding and hernia) are shared by both approaches, as are general comp lications of every endoscopic surgery, such as hemorrhage, gas loss and gas embolism. The laparoscopic approach is limited due to the risk of visceral damages (enhanced with previous open surgery) because of the transabdominal approach [29] , whereas pneumothorax and lesion of the 12th intercostals nerve are well-known complications of RPS [27,28] . Another drawback proposed for LS (and for all anterior approaches) was opening of the peritoneum to reach an extra-peritoneal organ.…”