Laparoscopic adrenal-sparing surgery for primary hyperaldosteronism due to aldosterone-producing adenoma

Kok, Kenneth Y.Y.; Yapp, S. K. S.

doi:10.1007/s00464-001-8127-5

Cited by 36 publications

(19 citation statements)

References 17 publications

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“…Some authors noted that tumors located anteriorly and on the margin of the gland are removed relatively easily, while those located posteriorly may be more complex. 18 However, the large proportion of pheochromocytoma cases in this review argue that even those tumors that are surgically challenging, originating in the adrenal medulla and less likely on the periphery of the gland, can still be safely and successfully resected with a partial adrenalectomy. While location may indeed be an important factor in the decision to perform adrenal sparing surgery, the more likely explanation for Conn's tumors being the most common tumor removed by partial adrenalectomy is either due to the overall higher incidence of aldosterone producing adenomas compared to other adrenal tumors or selection bias based on our methodology.…”

Section: Discussionmentioning

confidence: 89%

Partial Adrenalectomy: Underused First Line Therapy for Small Adrenal Tumors

et al. 2010

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Purpose Many patients with small adrenal masses undergo total adrenalectomy. We evaluate the outcomes of partial adrenalectomy by performing a comprehensive literature review. Materials and Methods We performed a Pubmed search of literature published in the English language using the following queries: “partial adrenalectomy” and “adrenal sparing surgery”, and identified 317 and 155 articles, respectively. We excluded case reports or series containing less than 5 patients, articles not focused on surgical management, and those that did not indicate perioperative outcomes. The remaining articles were cross-referenced by author and institution in order to eliminate studies with redundant cases. Demographics, diagnosis, tumor characteristics, perioperative and functional outcomes, as well as recurrence data was collected when available. Results Twenty-two articles from 22 first authors met our inclusion criteria describing outcomes of 417 patients. There is an increasing trend towards utilization of partial adrenalectomy worldwide over the past 20 years. Partial adrenalectomy is most commonly performed for Conn's Syndrome, followed by pheochromocytoma. Most of the procedures are performed laparoscopically with minimal morbidity. The recurrence rate is only at 3% and over 90% of patients remain steroid independent. Conclusions Surgical outcomes and perioperative complications of partial adrenalectomy are similar to those reported for total adrenalectomy. When partial adrenalectomy is performed for small adrenal lesions, the rate of malignancy is negligible, the recurrence rate is low, and the vast majority of patients remain steroid independent at long-term follow up. These data strongly support acceptance of partial adrenalectomy as a first line treatment for small adrenal masses.

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Section: Discussionmentioning

confidence: 89%

Partial Adrenalectomy: Underused First Line Therapy for Small Adrenal Tumors

et al. 2010

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“…The vascular stapler is another instrument that provides excellent hemostasis during PA, although it lacks the precision of sutures or the ultrasonic scalpel [16,17,30]. Imai et al [31] were able to excise lesions with a 5-mm margin of normal tissue in five patients when lesions were in the superior or inferior portions of the adrenal gland.…”

Section: Surgical Techniquesmentioning

confidence: 98%

“…More recently, Kok and Yapp [17] performed a 2-year prospective review of eight patients with primary hyperaldosteronism due to APA who underwent transperitoneal LPA. Adenomas (mean diameter, 2 cm) were removed via enucleation (n = 7) and with a vascular stapler (n = 1).…”

Section: Adrenal Adenomamentioning

confidence: 98%

Adrenal-preserving minimally invasive surgery: The role of laparoscopic partial adrenalectomy, cryosurgery, and radiofrequency ablation of the adrenal gland

2003

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Adrenalectomy has become the standard of care for the management of hormonally active adrenal masses. Various surgical therapies have been proposed to excise completely or destroy these adrenal lesions, which may be benign or malignant. New minimally invasive, adrenal-sparing procedures have recently been introduced, among them laparoscopic partial adrenalectomy, cryosurgery, and radiofrequency ablation. These procedures focus on reducing patient morbidity and hastening postoperative recovery while preserving normal adrenal tissue. However, questions remain about the risks and benefits associated with routine application of minimally invasive therapies for adrenal-sparing surgery in terms of complete tumor extirpation. Clearly, more experience and longer follow-up is necessary to validate these procedures. Herein we describe the surgical techniques and early results of treatment with adrenal-sparing surgery.

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“…The vascular stapler has also been used during LPA to excise lesions and provide hemostasis [39,41,42]. One concern with the stapling device is that it is not as precise as other methods of excision.…”

Section: Surgical Techniquesmentioning

confidence: 99%

Adrenal-preserving minimally invasive surgery: Update on the current status of laparoscopic partial adrenalectomy

Disick¹,

Munver

2008

Curr Urol Rep

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Adrenalectomy is the standard of care for hormonally active adrenal masses. In recent years, minimally invasive laparoscopic excision has become a preferred management option. As with advances in parenchymal-sparing renal surgery, investigators have begun to examine adrenal-sparing procedures to preserve functional adrenal tissue. This article reviews the recent literature and reports on intermediate results with laparoscopic partial adrenalectomy (LPA).

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Laparoscopic adrenal-sparing surgery for primary hyperaldosteronism due to aldosterone-producing adenoma

Abstract: Laparoscopic transperitoneal adrenal-sparing surgery is safe and effective in the treatment of patients with primary hyperaldosteronism due to aldosterone-producing adenoma.

Cited by 36 publications

References 17 publications

Partial Adrenalectomy: Underused First Line Therapy for Small Adrenal Tumors

Partial Adrenalectomy: Underused First Line Therapy for Small Adrenal Tumors

Adrenal-preserving minimally invasive surgery: The role of laparoscopic partial adrenalectomy, cryosurgery, and radiofrequency ablation of the adrenal gland

Adrenal-preserving minimally invasive surgery: Update on the current status of laparoscopic partial adrenalectomy

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