Laparoscopic Partial Adrenalectomy

Abstract

RezumatSuprarenalectomia laparoscopicã a devenit gold standard pentru afecţiunile suprarenalei, de la incidentalom pânã la cancer. Suprarenalectomia parţialã este greu de acceptat din cauza dificultãţilor tehnice şi a riscurilor hemoragie, nefiind stabilit un consens. Pe de altã parte, în cazuri selecţionate de tumori benigne, suprarenalectomia poate fi excesivã, rezecţiile parţiale fiind perfect justificate cu risc hemoragic scãzut. Pentru tumori secretante de dimensiuni sub 3 cm, cu localizare anterioarã sau lateralã, suprarenalectomia parţialã poate fi indicatã. Reperele principale sunt reprezentate de identificarea adenomului, conservarea ţesutului glandular restant împreunã cu sursele vasculare şi disecţia precisã cu menţinerea spaţiului de clivaj între adenom şi restul parenchimului. Suprarenalectomia parţial laparoscopicã este fezabilã şi eficientã pentru tratamentul tumorilor de mici dimensiuni mai ales în localizãrile bilaterale. Aceste avantaje sunt contrabalansate de o tehnicã chirurgicalã mai dificilã.Cuvinte cheie: chirurgie laparoscopicã, suprarenalectomie, rezecţie suprarenalianã parţialã AbstractLaparoscopic adrenalectomy became the gold standard for adrenal disease, from incidentaloma to cancer. Partial adrenalectomy is difficult to accept due to its technical difficulties as well as hemorrhagic risk and a consensus has not been reached. On the other hand, in selected cases of benign adrenal tumors, adrenalectomy may be futile, partial resections being perfectly justified and with lower hemorrhagic risks. For functioning tumors smaller than 3 cm with an anterior or lateral location, partial adrenalectomy may be indicated. The key points reside in adenoma identification, preservation of the remaining glandular parenchyma and its blood supply with dissection in the space between the adenoma and the normal parenchyma. Laparoscopic partial adrenalectomy is feasible and effective for the treatment of benign tumors.

Partial Adrenalectomy - Arguments for the Minimally Invasive Surgical Approach

“…As for the indications of partial adrenalectomy, the procedure is commonly performed for patients presenting solitary adrenal glands, bilateral adrenal tumors or hereditary syndromes which predispose to the apparition of multiple adrenal masses; therefore, cases diagnosed with bilateral aldosterone producing adenomas, cortisol producing adenomas, pheochromocytomas and nonfunctional tumors seem to be the most commonly encountered candidates (14,15). Moreover, cases presenting solitary, small tumors might be submitted to partial adrenalectomy in order to preserve the normal parenchyma and to diminish the potential risk of adrenal insufficiency if further contralateral gland surgery is needed (6,7,16).…”

Gender, Age, and Concomitant Diseases of Colorectal Diverticulum in China: A Study of 7,964 Cases

“…Currently, there has been no consensus on the gender distribution of CRD [13,14]. A previous study speculated that hormonal changes may be an important factor contributing to the gender difference in the CRD prevalence [15]. We propose that the increase in the detection rate of CRD in elderly women might involve multiple factors, including aging, unique female pelvic structure, hormonal change in women, intake of antiobesity drugs, and the potential diet difference between male and female, and so on.…”

Risk Assessment and Learning Curve in Laparoscopic Transperitoneal Adrenalectomy - Early and Late Experience of a Single Team

“…Extracapsular dissection with preservation of the capsule of the adrenal is recommended, but partial adrenalectomy has been reported with very good results for a variety of benign conditions, especially for bilateral adrenal masses, and avoids medical adrenal replacement (26,27). The amount of cortical tissue needed for normal function is 1/3 of one gland and blood supply needs to preserved without mobilization out of the retroperitoneum (28).…”

“…Between 2016 and 2019, 4 partial laparoscopic adrenalectomies were performed for Cushing's Syndrome. Two young female patients received sequential bilateral partial laparoscopic adrenalectomies for Cushing's Syndromes with bilateral secreting adenomas, both of them being asymptomatic at present and not needing substitution treatment (27).…”