Management of adrenal incidentaloma by laparoscopic transperitoneal anterior and submesocolic approach

Paganini, Alessandro M.; Guerrieri, Mario; Balla, Andrea; Quaresima, Silvia; Isidori, Andrea M.; Iafrate, Franco; D’Ambrosio, Giancarlo; Lezoche, Giovanni; Lezoche, Emanuele

doi:10.1007/s00423-015-1367-y

Cited by 14 publications

(61 citation statements)

References 52 publications

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“…Minimally, invasive adrenalectomy is mostly performed either with a transperitoneal lateral approach or with a retroperitoneal approach [4]. The laparoscopic transperitoneal anterior approach has been proposed only by few centers [8,11,19,23,24,26].…”

Section: Discussionmentioning

confidence: 99%

“…In order to establish the diagnosis in case of adrenal secreting lesions, all patients undergo complete hormonal evaluation as previously reported [11]. Diurnal serum cortisol, dehydroepiandrosterone (DHEAS), plasma adrenocorticotropic hormone (ACTH), testosterone, androstenedione, urinary free cortisol (UFC), 17-hydroxyprogesterone (17-OHP), renin activity, aldosterone and urinary catecholamine levels are measured, together with overnight 1-mg dexamethasone suppression test (DST) [11].…”

Section: Methodsmentioning

confidence: 99%

“…Aldosterone-producing adenoma, pheochromocytoma and Cushing's syndrome are diagnosed on the basis of high plasma aldosterone, plasma renin activity (PRA) ratio (>40) and unsuppressed aldosterone after sodium load, elevated urinary metanephrines, elevated UFC, abnormal serum cortisol, inadequate cortisol suppression after 1-mg dexamethasone and low and/or suppressed plasma ACTH [11]. When no specific signs and/or symptoms of autonomous hormone secretion are present, or abnormal hypothalamus-pituitary-adrenal axis tests and radiological imaging suggesting the presence of an adrenocortical lesion, a diagnosis of nonfunctioning adenoma is made [11].…”

Section: Methodsmentioning

confidence: 99%

“…Diurnal serum cortisol, dehydroepiandrosterone (DHEAS), plasma adrenocorticotropic hormone (ACTH), testosterone, androstenedione, urinary free cortisol (UFC), 17-hydroxyprogesterone (17-OHP), renin activity, aldosterone and urinary catecholamine levels are measured, together with overnight 1-mg dexamethasone suppression test (DST) [11]. Aldosterone-producing adenoma, pheochromocytoma and Cushing's syndrome are diagnosed on the basis of high plasma aldosterone, plasma renin activity (PRA) ratio (>40) and unsuppressed aldosterone after sodium load, elevated urinary metanephrines, elevated UFC, abnormal serum cortisol, inadequate cortisol suppression after 1-mg dexamethasone and low and/or suppressed plasma ACTH [11]. When no specific signs and/or symptoms of autonomous hormone secretion are present, or abnormal hypothalamus-pituitary-adrenal axis tests and radiological imaging suggesting the presence of an adrenocortical lesion, a diagnosis of nonfunctioning adenoma is made [11].…”

Section: Methodsmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Laparoscopic Left Adrenalectomy with Submesocolic and Retropancreatic Approach

Balla¹,

Quaresima²,

Seitaj³

et al. 2017

Laparoscopic Surgery

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“…Bár ezek nagy része hormonálisan inaktív jóindulatú daganatként nem okoz tünetet, s csupán véletlensze-rűen, más betegség kapcsán végzett képalkotó vizsgálat során fedezik fel (incidentaloma) [3], a ritka hormonszekretáló adenomák súlyosan ronthatják a betegek élet-minőségét. A mellékvesekéreg-rák ugyanakkor egy igen ritkán előforduló (incidencia: 0,5-2/millió/év), rossz prognózisú, agresszív daganat, mely a mai napig kihívást jelent mind diagnosztikai, mind kezelési szempontból.…”

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A mikro-RNS-ek patogenetikai és diagnosztikai szerepe mellékvesekéreg-carcinomában

et al. 2018

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A mellékvesekéreg daganatos elváltozásai a népesség jelentős részét érintik. E daganatok többsége jóindulatú, hormonálisan inaktív mellékvesekéreg-adenoma. A ritka hormontermelő mellékvesekéreg-adenomák súlyos klinikai kö-vetkezményekkel járó betegségeket okoznak, a kifejezetten ritka mellékvesekéreg-carcinoma prognózisa ugyanakkor előrehaladott stádiumaiban nagyon rossz. E daganatok patogenezise a mai napig nem teljesen tisztázott. A mikro-RNS-ek kisméretű nem kódoló RNS-molekulák, amelyek a génexpresszió poszttranszkripciós szabályozása révén jelentős szerepet töltenek be számos alapvető sejtbiológiai folyamatban. Megváltozott kifejeződésüket számos daganatban leírták. Több szöveti mikro-RNS, így a miR-483-5p, a miR-503, a miR-210, a miR-335 és a miR-195 megváltozott kifejeződését találták jó-és rosszindulatú mellékvese-daganatok között, és ezeknek patogenetikai jelentősé-gük is lehet. A mikro-RNS-ek szövetspecifikus és stabil kifejeződésüknek köszönhetően a diagnosztikában is felhasználhatók lehetnek. Tekintettel arra, hogy a mellékvesekéreg-daganatok szövettani diagnózisa nehéz, a szöveti mikro-RNS-ek segíthetnek a malignitás megállapításában is. Új eredmények igazolták, hogy a mikro-RNS-ek külön-böző testnedvekbe is kiválasztódnak, ami a folyadékbiopszia módszere révén biomarkerként történő felhasználható-ságukat vetíti előre. Összefoglaló cikkünkben a mikro-RNS-ek mellékvesekéreg-daganatokban betöltött patogenetikai szerepét és diagnosztikai alkalmazási lehetőségeit tekintjük át. Orv Hetil. 2018; 159(7): 245-251. Kulcsszavak: mellékvesekéreg-rák, mikro-RNS, szöveti, keringő, extracellularis vesicula Pathogenic and diagnostic roles of microRNAs in adrenocortical tumoursAdrenocortical tumours are quite prevalent. Most of these tumours are benign, hormonally inactive adrenocortical adenomas. Rare hormone-secreting adrenocortical adenomas are associated with severe clinical consequences, whereas the prognosis of the rare adrenocortical cancer is rather poor in its advanced stages. The pathogenesis of these tumours is only partly elucidated. MicroRNAs are small, non-coding RNA molecules that are pivotal in the regulation of several basic cell biological processes via the posttranscriptional regulation of gene expression. Their altered expression has been described in many tumours. Several tissue microRNAs, such as miR- 483-5p, miR-503, miR-210, miR-335 and miR-195 were found to be differentially expressed among benign and malignant adrenocortical tumours, and these could also have pathogenic relevance. Due to their tissue specific and stable expression, microRNAs can be exploited in diagnostics as well. As the histological diagnosis of adrenocortical malignancy is difficult, microRNAs might be of help in the establishment of malignancy. Novel data show that microRNAs are secreted in various body fluids, projecting their applicability as biomarkers as part of liquid biopsy. In this review, we attempt to present a synopsis on the pathogenic relevance of microRNAs in adrenocortical tumours and their potential di...

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