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PubMed2002

Laparoscopic lateral adrenalectomy versus open posterior adrenalectomy for the treatment of benign adrenal tumors.

BACKGROUND: Minimally invasive techniques play an important role in adrenal gland surgery. The objective of this study was to compare laparoscopic transabdominal adrenalectomy in the lateral position to the open posterior adrenalectomy with respect to the intraoperative and the short-term postoperative course. METHODS: Forty laparoscopic adrenalectomies (LA) carried out between July 1998 and August 2001 were compared to 30 open posterior operations (PA) performed between July 1994 and June 1998. In all cases the indications for surgery was a benign lesion smaller than 8 cm. RESULTS: Age, gender, tumor size, and distribution of the tumor histology were comparable in both groups (LA vs PA). In favor of LA, statistically significant differences (p <0.05) were observed regarding the intraoperative blood loss (260 vs 380 mL), the postoperative narcotic equivalents (2.9 vs 6.4 mg), the morbidity rate (13 vs 27%), and the length of hospital stay (7 vs 10 days). Average operating time was significantly longer for LA (135 vs 106 min). There were two conversions to open adrenalectomy due to diffuse bleeding. Following LA, we observed one major complication (postoperative bleeding from the spleen making a laparotomy necessary) and four minor complications (one small retroperitoneal hematoma, two subcostal nerve irritations, one pleural effusion). PA resulted in one major (wound infection) and seven minor complications (two subcutaneous hematomas, two nerve irritations, two pleural effusions, one dystelectasis). CONCLUSIONS: Laparoscopic adrenalectomy proved as a safe and reliable procedure, displaying all advantages of minimal access surgery. In our institution, it has become the standard technique employed for benign adrenal disease. However, the operation is technically demanding, and as adrenal surgery is rare, it should be restricted to centers with special interest in laparoscopic and endocrine surgery.

Adenoma↗
PubMed2003

[Comparative study on transperitoneal retroperitoneal laparoscopic adrenalectomy and open adrenalectomy for adrenal tumours].

OBJECTIVE: To compare and evaluate the clinical value among transperitoneal, retroperitoneal laparoscopic adrenalectomy and open adrenalectomy for the treatment of adrenal tumours. METHODS: From January 1996 to June 2002, transperitoneal laparoscopic adrenalectomy (TLA) was performed for 19 cases, 17 cases were successful (Group A), retroperitoneal laparoscopic adrenalectomy (RLA) for 21 cases, 19 cases were successful (Group B), during the same period 41 patients with adrenal tumours under 6 cm in diameter underwent open adrenalectomy (Group C). The procedure was evaluated and compared in the respects of tumors weight, operation time, blood loss, recovery time of GI function, hospital stay, complications transferable rate and indications among three groups. RESULTS: Average tumors weight was (13.86) g in group A, (15.66) g in group B and (18.03) g in group C; mean operating time: group A was 17.21 min longer than group B, group A. B was 48.53 min longer and 31.32 min longer han group C respectively, mean blood loss in group A. B was less diminished by 121.55 ml and 137.05 ml than group C, and the blood loss in group B was less diminished by 15.50 ml than group A; mean recovery of Gl function, group A and B was 1.87 day and 2.17 day earlier than group C respectively, group B was 0.3 day earlier than group A, mean hospital stay was 2.60 day and 3.87 day shorter than group C, group B was 1.27 day shorter, than group A; transferable rate of operation was 10.5% (group A) and 9.5% (group B). Postoperative complication rate was 10.5%, 14.3% and 9.7% in group A. B and C respectively. CONCLUSIONS: TLA and RLA were better than open method. On the hand of approach to adrenal gland disturbs to abdominal organ and postoperative recovery on RLA have some slight advantage.

Adrenal Gland Neoplasms↗
PubMed2006

Laparoscopic adrenalectomy versus open adrenalectomy: results from a retrospective comparative study.

The relatively new operation of laparoscopic adrenalectomy has now become the procedure of choice for the management of most benign adrenal tumours. We have reviewed the data relating to the first 25 patients on whom we performed laparoscopic adrenalectomy and have made comparison with a group of 25 diagnosis-matched individuals on whom we had previously carried out open adrenalectomy. The patients who underwent laparoscopic adrenalectomy had a significantly shorter hospital stay and experienced significantly less postoperative morbidity than those who had an open operation, but the operation time was significantly longer for the laparoscopic group of patients. There is now good potential and sound evidence base for extending the indications for laparoscopic adrenalectomy.

Adrenalectomy↗
PubMed1997

Retroperitoneal laparoscopic adrenalectomy for functioning adrenal tumors: comparison with conventional transperitoneal laparoscopic adrenalectomy.

PURPOSE: We attempted to confirm the possibility and feasibility of laparoscopic adrenalectomy via the retroperitoneal approach, and to compare results of the transperitoneal and retroperitoneal approaches. MATERIALS AND METHODS: Three men and 8 women (mean age 39.6 years) with functioning adrenocortical tumors (primary aldosteronism in 5 and Cushing's syndrome in 6) underwent laparoscopic adrenalectomy via the retroperitoneal approach using a balloon dissection technique and a newly developed ultrasonic aspirator. Results were compared to those of 27 cases of transperitoneal laparoscopic adrenalectomy. RESULTS: Although the retroperitoneal approach was successful in all 5 patients with primary aldosteronism, it succeeded in only 2 of the 6 cases of Cushing's syndrome. In 3 Cushing's syndrome cases the retroperitoneal approach was changed to the transperitoneal laparoscopic approach due to difficulty in exploration. Open laparotomy was required in 1 case of left Cushing's syndrome because of an inadvertent pancreatic injury. Subcutaneous emphysema developed in 6 patients without hypercapnia or prolonged postoperative symptoms. Mean operative time and blood loss, and time to oral intake and ambulation were 248.3 minutes, 151.4 ml., and 1.55 and 2 days, respectively. There was no difference between retroperitoneal and conventional transperitoneal laparoscopic adrenalectomy in regard to these factors or to convalescence. CONCLUSIONS: Retroperitoneal laparoscopic adrenalectomy is feasible for primary aldosteronism. However, Cushing's syndrome is presently a much more difficult indication than primary aldosteronism for this new operative technique.

Adrenal Cortex Neoplasms↗
PubMed2000

Laparoscopic adrenalectomy for functioning adrenal tumors: clinical experiences with 38 cases and comparison with open adrenalectomy.

We reviewed 38 cases of transperitoneal or retroperitoneal laparoscopic adrenalectomy for unilateral benign functioning adrenal tumors and compared the results with those of a recent series of 36 patients undergoing an open adrenalectomy. The tumors were removed successfully in all but two cases with laparoscopy that required open laparotomy. In the other 36 cases of the laparoscopy group, mean operative time and blood loss were 225 minutes and 138 mL, respectively. Mean operative time was significantly longer for the laparoscopy group (122 minutes for open surgery: P < 0.0001), whereas mean blood loss of the laparoscopy group was almost equal to that of the open surgery group. Mean intervals to first ambulation and oral intake, and postoperative hospital stay of the laparoscopy group were significantly less than those of the open surgery group (1.4 vs 2.0 days: P = 0.014; 1.8 vs 2.9 days: P < 0.0001; and 8.5 vs 12.9 days: P < 0.0001, respectively). We conclude that laparoscopic adrenalectomy is equally effective and less invasive than open adrenalectomy. and that it should be considered as the first-choice therapy for benign adrenal tumors.

Adrenal Gland Neoplasms↗
PubMed1997

[Clinical study of gasless laparoscopic adrenalectomy in 17 cases--comparison between laparoscopic adrenalectomy with and without pneumoperitoneum].

PURPOSE: To determine the efficiency of gasless laparoscopic adrenalectomy, this procedure was compared to that with pneumoperitoneum. PATIENTS AND METHODS: Between February 1994 and December 1996, 17 gasless laparoscopic adrenalectomy were performed in 5 men and 12 women, 36 to 79 years old. Clinical diagnosis was primary aldosteronism in 8, pheocromocytoma in 2, incidentaloma in 4 and adrenal cyst in 3. When gasless laparoscopic adrenalectomy was performed, the laparoscope was inserted through the upper margin of the umbilicus by open laparotomy. To create a workable space, a 1.2 mm Kirschner wire was advanced subcutaneously below the costal arch and attached to a retractor. Operating time, estimated blood loss, changes of the end tidal CO2 concentration during operation, operative complications and postoperative course were compared to those with pneumoperitoneum in 12 cases. RESULTS: In both procedures, satisfying workable spaces were created in all cases. The mean operating time and estimated blood loss were 245 min and 201 ml without pneumoperitoneum, 317 min and 274 ml with pneumoperitoneum, respectively. The mean changes of end tidal CO2 concentration during operation were 3.2 mmHg without pneumoperitoneum and 5.1 mmHg with pneumoperitoneum. As operative complications, open operations were required in 2 cases (1 without pneumoperitoneum and another with pneumoperitoneum) to control intraoperative bleeding. They had the histories of transabdominal operations. Postoperative bleeding was observed in 2 cases (1 without pneumoperitoneum and another with pneumoperitoneum). One of them (with pneumoperitoneum) needed surgical management for hemostasis. Fever over 38 degrees C that occurred in 1 case with pneumoperitoneum appeared to be absorption fever. No differences were observed in the number of the days to the start of oral intake and for postoperative hospitalization between the two groups. CONCLUSIONS: Gasless laparoscopic adrenalectomy is available for most adrenal tumors. Suction could be used unrestrictedly and there were no hemodynamic or ventilatory effects due to pneumoperitoneum. This procedure appears to be safe and advantageous for the treatment of most adrenal tumors.

Adrenal Gland Diseases↗
PubMed2006

[Open adrenalectomy for adrenal metastases from lung cancer--usefulness and problem of laparoscopic adrenalectomy].

We examined the outcome of open adrenalectomy performed at our hospital to determine the effectiveness and problems of laparoscopic adrenalectomy for adrenal metastases from lung cancer. Between January 2001 and June 2004, eight open adrenalectomies were performed on six patients with adrenal metastases from lung cancer. Surrounding adhesion was observed in five of the eight cases (63%). The recurrence period was 17.8 months and 5.3 months in the cases with and without adhesion, respectively. Laparoscopic adrenalectomy for adrenal metastases may be safe and effective. However, potential surrounding adhesions meed to be adequately considered, if the primary lesion is the lung.

Adenocarcinoma↗
PubMed1989

[Subtotal adrenalectomy versus autotransplantation of the adrenal cortex--an alternative procedure in bilateral adrenalectomy in MEN II?].

Complete loss of steroid production is a very remarkable effect of total adrenalectomy. This is the reason why attempt was made to preserve some adrenal cortex function in cases with bilateral adrenalectomy. Till now successful autografting of adrenal cortex has been reported only in cases with Cushing's syndrome. We now report on two cases with MEN II syndrome, in whom autografting into the rectus muscle was done successfully. In order to compare results, data on two patients with subtotal adrenalectomy are given. Outcome was similar. In all 4 cases function of adrenal cortex was demonstrated by scintigraphy and by blood chemistry. In one case with autotransplantation and in another with subtotal resection, the remaining adrenal tissue showed response to ACTH. Provided more experience, in our opinion subtotal adrenalectomy and adrenal autotransplantation in cases of MEN II syndrome might turn out to prove as equivalent procedures.

Abdominal Muscles↗
PubMed2004

Extent of adrenalectomy for adrenal neoplasm: cortical sparing (subtotal) versus total adrenalectomy.

The standard operation on adrenal neoplasias is a complete adrenalectomy. Accepted exceptions are bilateral inherited pheochromocytomas. In these cases, clinical and biochemical cure, as well as preservation of cortical function, can be achieved by a noncomplete adrenalectomy. In that procedure, at least one third of one gland has to be preserved. In unilateral adrenal tumors, partial resection has been used, especially in Conns adenomas, with early results comparable to those of total adrenalectomy. Because longterm results are still limited in hyperaldosteronism, final conclusions are not possible today.

Adenoma↗
PubMed2004

Laparoscopic adrenalectomy for pheochromocytoma: comparison with conventional open adrenalectomy.

PURPOSE: To compare the effectiveness and efficacy of laparoscopic transperitoneal adrenalectomy (LTA) with those of open adrenalectomy (OA) in patients with pheochromocytoma. PATIENTS AND METHODS: Among 24 patients (13 male, 11 female) who underwent surgical removal of pheochromocytoma, LTA and OA were performed in 15 and 9, respectively. The mean age was 45.2 years in the LTA group and 43.3 years in the OA group, and the mean tumor size was 5.2 +/- 2.0 (SE) cm and 6.4 +/- 2.6 cm, respectively. Retrospective analysis of their clinical outcomes was performed. The mean follow-up for OA and LTA groups was 36 months and 22 months, respectively. RESULTS: The mean operative time was 171 +/- 66.7 minutes in the LTA group and 200 +/- 73.3 minutes in the OA group. The mean blood loss was 189.5 +/- 50.4 mL and 397.1 +/- 144.7 mL, respectively (P = 0.0341). The mean number of intraoperative hypertensive crises was 0.6 +/- 0.5 during LTA and 1.67 +/- 1.1 during OA (P = 0.0146). In the LTA group, there were no conversions to open surgery and no intraoperative complications, and the blood pressure was well managed intraoperatively without medication. The mean time to oral intake was 1.1 +/- 0.3 days after LTA and 2.6 +/- 1.3 days after OA (P = 0.0037). The mean postoperative hospital stay was 5.6 +/- 2.0 days in the LTA group and 12.4 +/- 3.5 days in the OA group (P = 0.0001). Patient-controlled analgesia was needed by 2 patients (13.3%) in the LTA group and 6 (66.7%) in the OA group (P = 0.0413). In the OA group, three pneumothoraces and one case of sepsis occurred. After a mean follow-up of 36 months, two patients in the OA group redeveloped hypertension. With a mean follow-up of 22 months, none of the 15 LTA patients redeveloped hypertension. CONCLUSIONS: Laparoscopic adrenalectomy for pheochromocytoma is a safe and effective prodcedure providing the benefits of a minimally invasive approach.

Adrenal Gland Neoplasms↗
PubMed1999

Unilateral laparoscopic adrenalectomy followed by contralateral retroperitoneoscopic partial adrenalectomy in a patient with multiple endocrine neoplasia type 2a syndrome.

We report the first patient who had bilateral pheochromocytoma associated with multiple endocrine neoplasia type 2a syndrome (MEN 2a) and underwent unilateral laparoscopic adrenalectomy followed by contralateral retroperitoneoscopic partial adrenalectomy 2 years later. The postoperative course was uneventful both times, and the patient was cured of hypertension without any need for steroid replacement. Endoscopic partial adrenalectomy is a minimally invasive procedure for pheochromocytoma with mild symptoms. We believe that this procedure has considerable potential for treating bilateral pheochromocytoma, which is frequently observed in patients with MEN 2a.

Adrenal Gland Neoplasms↗
PubMed1995

Adrenalectomy via the dorsal approach: a benchmark for laparoscopic adrenalectomy.

PURPOSE: We reviewed our experience with posterior surgical excision of aldosteronomas. MATERIALS AND METHODS: A retrospective review identified 40 consecutive cases performed by 1 surgeon. RESULTS: Mean patient age was 46 years and mean blood loss was 237 cc. There was no perioperative mortality or intraoperative complications. Times to unassisted ambulation and return to a normal diet were 2.2 and 2.4 days, respectively, with a mean postoperative hospital stay of 4.4 days. CONCLUSIONS: The removal of aldosteronomas via the dorsal approach is a safe reliable technique with acceptable morbidity. These results provide a benchmark by which the results of laparoscopic adrenalectomy may be judged.

Adrenal Cortex Neoplasms↗