Laparoscopic adrenalectomy: A new standard of care

Vargas, Hernan I.; Kavoussi, Louis R.; Bartlett, David L.; Wagner, Joseph R.; Venzon, David; Fraker, Douglas L.; Alexander, H. Richard; Linehan, W. Marston; Walther, McClellan M.

doi:10.1016/s0090-4295(97)00083-6

Cited by 165 publications

(103 citation statements)

References 13 publications

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“…Interestingly, a creation of peritoneum has been shown to increase catecholamines release which may result in hemodynamic instability (35,48,49). Moreover, case control studies confirmed that in terms of hemodynamic instability laparoscopic approach is equal to open procedure (50,51). Moreover, a study by Kiernan et al demonstrated that after open surgery the risk of increased number of episodes of systolic blood pressure >200 mmHg was 27 times higher comparing to laparoscopy (52).…”

Section: Intraoperative Considerationsmentioning

confidence: 98%

Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

Pisarska¹,

Pędziwiatr²,

Budzyński³

2016

Gland Surg.

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Section: Intraoperative Considerationsmentioning

confidence: 98%

Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

Pisarska¹,

Pędziwiatr²,

Budzyński³

2016

Gland Surg.

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“…In our opinion, this was because of a combination of factors including adequate preoperative preparation, careful perioperative monitoring, skilled anesthetic intervention and most importantly increasing operative experience. As described by other authors, learning curve may play a signifi cant role in improving the effi ciency and safety of advanced laparoscopic procedures [27].…”

Section: Discussionmentioning

confidence: 86%

Laparoscopic adrenalectomy — a review of initial 24 consecutive patients

et al. 2007

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Aim To analyze patient demographics, pathology, surgical procedure and outcome in initial 24 consecutive patients who underwent laparoscopic adrenalectomy in our department.Methods Twenty four patients underwent laparoscopic adrenalectomy between September 2000 and August 2005. There were 12 males and 12 females with a mean age of 44.6 years ( range 25-68 years ). The indications for adrenalectomy were pheochromocytoma (13 patients), Cushing's syndrome (5 patients), myelolipoma (2 patients), adrenal cyst (2 patients), aldosteronoma (1 patient) and adrenal incidentaloma (1 patient). Nineteen of our patients with functioning adrenal tumours were prepared preoperatively for periods ranging up to 2 weeks by the endocrinologist. All laparoscopic adrenalectomies were performed via lateral transperitoneal approach using standard four-port technique. Patients with pheochromocytoma and Cushing's syndrome were monitored in the surgical intensive care unit during immediate postoperative period. The clinical and intraoperative characteristics, complications and outcomes of all patients were analyzed. ResultsThe mean operative time for laparoscopic adrenalectomy was 136 minutes. Intraoperative hypertension occurred in 8 patients. Intraoperative hypotension occurred in 2 patients. One patient required conversion due to dense adhesions and hemorrhage. Postoperative complications were seen in six patients -immediate postoperative hypotension (2 patients), features of steroid withdrawal (2 patients) and postoperative pyrexia (2 patients). Five patients with pheochromocytoma required antihypertensive drugs in the postoperative period. There was no mortality in our series.Conclusions Laparoscopic adrenalectomy is a safe operation that incorporates all the benefi ts of minimal access surgery and is associated with a satisfactory postoperative outcome . A careful preoperative preparation in functioning adrenal tumours aids in the faster recovery of these patients.

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“…The surgical approach to the adrenal gland has raised debate among surgeons due to its retroperitoneal location and for the complexity in the management of secreting tumors, particularly in case of pheochromocytoma (PHE) [1][2][3]. Traditionally, open adrenalectomy is made difficult due to its deep anatomical location, and it is associated with up to 39% morbidity rate and prolonged hospital stay [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Left Adrenalectomy with Submesocolic and Retropancreatic Approach

Balla¹,

Quaresima²,

Seitaj³

et al. 2017

Laparoscopic Surgery

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Introduction: The safety and efficacy of laparoscopic transperitoneal lateral adrenalectomy and retroperitoneoscopic adrenalectomy have been reported. The aim is to report the authors' experience in laparoscopic left adrenalectomy with an alternative transperitoneal submesocolic and retropancreatic approach with patient supine. Research methods:The authors have performed laparoscopic transperitoneal submesocolic, retropancreatic adrenalectomy for both benign and malignant, functioning lesions >4cm in diameter or with smaller lesions but having an imaging pattern suspicious of malignancy or of sub-clinically secreting tumors. After opening the posterior peritoneum at the root of the transverse mesocolon and Gerota's fascia, the junction of the inferior adrenal vein with the left renal vein is identified. The adrenal vein is then prepared and divided, followed by mobilization and removal of the left adrenal gland.Conclusion: Early ligation of the adrenal vein is the most relevant technical feature of this procedure to avoid the release of catecholamines, hormones or neoplastic cells which could occur during manipulation of the gland prior to ligation of the main adrenal vein. Moreover, this approach makes it possible to perform associated procedures, including a bilateral adrenalectomy, without the need to reposition the patient on the operative table, but simply by positioning additional trocars.

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Laparoscopic adrenalectomy: A new standard of care

Cited by 165 publications

References 13 publications

Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

Laparoscopic adrenalectomy — a review of initial 24 consecutive patients

Laparoscopic Left Adrenalectomy with Submesocolic and Retropancreatic Approach

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