Tolerance of laparoscopy for resection of phaeochromocytoma

Abstract

We describe two patients who underwent resection of phaeochromocytoma by a laparoscopic approach. Although outcome from surgery was successful, there was marked variability in hormonal and haemodynamic changes. In one patient, despite an infusion of nicardipine, peritoneal insufflation produced a marked increase in catecholamine concentrations associated with transient but intense vasoconstriction, but there was no change in the second patient. In both patients, exsufflation caused no significant haemodynamic changes in spite of the high doses of nicardipine given throughout the procedures.

Laparoscopic resection of extra-adrenal pheochromocytoma—Case report and review of the literature in pediatric patients

“…α blockade with phenoxybenzamine in increasing doses and preoperative volume expansion is used as standard treatment [10]. Preparation over an adequate period (2 weeks) minimizes hemodynamic changes at induction and intraoperatively [11]. Selective use of β blockade is warranted mostly in adults with documented tachyarrhythmias.…”

“…After induction of general anesthesia (fentanyl with rocuronium), endotracheal intubation, and placement of an arterial line, urinary catheter, and nasogastric tube, the patient was placed in the right lateral decubitus position (45°).The patient was started on a combination of esmolol (25 μg/kg per minute), phentolamine (1.2 mg bolus prn), and nitropruside (2 μg/kg per hour) drips, with a norepinephrine and epinephrine on standby [10,11]. A 5-mm infra umbilical port was placed using the open technique.…”

Endoscopic adrenalectomy for pheochromocytoma: difference between the transperitoneal and retroperitoneal approaches in terms of the operative course

“…The removal of a pheochromocytoma is associated with specific risks, particularly the occurrence of hypertensive crises, which develop in 50% to 67% of patients because of increased catecholamine levels during the dissection of the tumor and the adrenal gland [9, [20][21][22]. To avoid the development of hypertensive crises, ligation of the adrenal vein before dissection of the organ has been recommended by various authors [10,13,22,23].…”

“…Various investigators have, however, reported comparable CO 2 absorption values for the retroperitoneal and transperitoneal procedures. The fact that the tendency to acidosis increases with prolonged operating times advocates the selection of the procedure with the shorter operating time [2,7,20].…”

Assessment of serum catecholamine concentrations in patients with pheochromocytoma undergoing videolaparoscopic adrenalectomy

“…Insufflation of pneumoperitoneum is associated with an increase in serum catecholamines, either by stimulus to mechanical compression or a change in tumor vascularization (11,12). Additionally, carbon dioxide used to insufflate the pneumoperitoneum can lead to hypercapnia, which would increase sympathetic tonus, thus changing tension levels (13).…”