Laparoscopic adrenalectomy

Abstract

In the last three decades, endoscopic adrenalectomy has become the gold standard for the surgical treatment of most adrenal diseases. Gagner et al., first reported in 1992, the lateral trans-abdominal laparoscopic approach to adrenalectomy. Afterwards, several retrospective and comparative studies addressed the advantages of minimally invasive adrenalectomy specifically consistent in less postoperative pain, improved patients' satisfaction, shorter hospital stay and recovery time when compared to open adrenalectomy. The lateral transabdominal approach to the adrenals is currently one of the most widely used, since it allows an optimal comprehensive view of the adrenal region and surrounding structures, and provides and adequate working space. On the other hand, from a technical point of view, essential requirements for a successful laparoscopic adrenalectomy are an appropriate knowledge of retroperitoneal anatomy, a gentle tissue manipulation and a precise haemostasis technique in order to identify appropriately the structures of interest and avoid the troublesome 'oozing' that could complicate the surgical procedure.

EUROCRINE®: Nebennierenoperationen 2015 bis 2019 – überraschende erste Ergebnisse

“…Die American Association of Endocrinologists gibt in ihren Empfehlungen zum Management von Inzidentalomen zu bedenken, dass Tumoren, welche initial nicht als Nebennierenrindenkarzinom erkannt wurden und sich intraoperativ als solches darstellen, eine Konversion von einer minimal-invasiven Adrenalektomie zu einer offenen Resektion rechtfertigen, da durch eine offen-chirurgische Versorgung das Risiko eines frühen Rezidivs und einer peritonealen Aussaat reduziert werden könne [4,[14][15][16][17]. Durch die bereits ähnliche Patientenlagerung bei der laparoskopischen Adrenalektomie könne im Vergleich zu retroperitoneoskopischen Verfahren eine raschere Konversion ermöglicht werden, welches sich vorteilhaft auswirke [18]. In Bezug auf die postoperative Komplikationsrate konnten Thompson et al jedoch in einer multivariaten Analyse von Adrenalektomien innerhalb des Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery (SQRTPA) zeigen, dass eine Konversion von minimal-invasiven Verfahren zur offen-chirurgischen Versorgung mit einem erhöhten Komplikationsrisiko assoziiert war, wohingegen der Faktor einer primär offen-chirurgischen Operation sich nicht signifikant auf das Auftreten postoperativer Komplikationen auswirkte [19].…”

Adrenalektomide endikasyonlar ve cerrahi seçenekler

“…[14] Laparoscopic transabdominal or retroperitoneoscopic operation, offer significant advantages over an open approach, including decreased hospital length of stay, postoperative pain, intraoperative blood loss, and overall 30-day postoperative complications, as well as mortality. [6,13]…”

“…In approximately 20% of cases, an accessory adrenal vein is encountered 2-3 cm above the main adrenal vein and, when present, should be dissected, clipped, and divided. [6] Alternatively, the adrenal vein can be divided with vascular staples. Then, the inferomedial side of the gland is dissected.…”

“…[4] In 1994, retroperitoneal adrenalectomy in humans has been described in different regions of the world. [5,6]…”

Modified three-level techniques of retroperitoneal laparoscopic procedures to treat adrenal lesions for patients with BMI ≥ 25 Kg/m2

“…Over the past three decades, laparoscopic adrenalectomy has replaced open adrenalectomy and become the gold standard for surgical treatment of most adrenal diseases 1 . Transperitoneal laparoscopy is one of the most widely used adrenal approaches 2 because it allows for the best comprehensive observation of the adrenal region and its surrounding tissues.…”