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PubMed1995

Partial adrenalectomy for renal cell carcinoma with bilateral adrenal metastases.

Resection of the adrenal glands precludes participation in many immunotherapy protocols for metastatic renal cell carcinoma. We performed radical nephrectomy with adrenalectomy and contralateral partial adrenalectomy, including adrenal vein ligation for a 4 cm. hilar metastasis without perioperative complications or local recurrence after 30 months. Adrenal function, measured by cosyntropin stimulation tests 6 weeks and 10 months postoperatively, was normal. Partial adrenalectomy with preservation of adrenal function is possible.

Adrenal Gland Neoplasms↗
PubMed1994

[Endoscopic adrenalectomy by retroperitoneal approach for primary aldosteronism].

Endoscopic adrenalectomy by a retroperitoneal approach through the skin incision less than 5 cm has been performed in 6 patients (3 males and 3 females; 4 right and 2 left side) with primary aldosteronism from December 1992 to June 1993. The treatment was successful in all the cases. As for complications, pneumothorax occurred in one case. The required operation time was from 120 to 330 min (mean: 196 min) and the blood loss was from 20 to 279 ml (mean: 94 ml), which were similar to those in open adrenalectomy. The retroperitoneal approach was thought to be more advantageous than widely adopted laparoscopic adrenalectomy in the following points: (1) No complications such as pulmonary embolism or pneumomediastinum. (2) No injuries to the intraabdominal organs. (3) Two operators using one video system is sufficient.

Adenoma↗
PubMed1994

Laparoscopic adrenalectomy for primary aldosteronism: report of initial ten cases.

BACKGROUND: Although laparoscopic technique has become popular in the surgical field, the value of laparoscopy in the removal of adrenal gland is unknown. The objective of this study was to examine the feasibility of laparoscopic adrenalectomy. METHODS: Between January 17, 1992, and March 16, 1993, 10 patients (four men, six women; mean, 48.2 years of age) with primary aldosteronism underwent laparoscopic adrenalectomy (seven of left adrenal gland and three of right adrenal gland) with almost the same devices as laparoscopic cholecystectomy. RESULTS: Adrenal tumors were successfully removed with adjacent normal adrenal gland in every patient. The operative time ranged from 165 to 572 minutes (mean, 295 minutes), and the operative bleeding ranged from 50 to 920 ml (mean, 270.5 ml) without requiring blood transfusion. Only one patient required open hemostasis because of uncontrollable bleeding complicated by dislocation of vascular clip in spite of successful laparoscopic removal of adrenal tumor. There was no major complication except for this case. CONCLUSIONS: Laparoscopic adrenalectomy is a relatively safe, alternative operative method for primary aldosteronism, but application of this technique to other types of adrenal lesions remains to be studied.

Adrenalectomy↗
PubMed1993

Should radical nephrectomy include ipsilateral adrenalectomy?

We reevaluated 46 patients with histopathologically proven stage A and B renal cell carcinoma, who underwent radical nephrectomy for the presence of ipsilateral adrenal gland in the surgical specimens. It turned out that 23 specimens included ipsilateral adrenals. Two patients without adrenalectomy relapsed locally, whereas no local recurrence was noted in patients whose adrenals were removed. Three years' disease-free survival rates (DFS) for patients with and without adrenalectomy were 100% and 78%, respectively. Although no statistical difference was found in terms of DFS between patients with and without adrenalectomy, we suggest the removal of the ipsilateral adrenal gland if technically feasible.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

Left adrenalectomy in varicocelized rats does not inhibit the development of varicocele-related physiologic alterations.

OBJECTIVE: To evaluate the importance of retrograde adrenal metabolite flow for testicular function in a varicocelized animal model. MATERIALS AND METHODS: Partial occlusion of the left renal vein and ligation of the collateral vein between the left testicular and left common iliac veins was carried out on 14 Wistar rats (group A); same procedure plus adrenalectomy on 14 others (group B); seven sham operated (C) and seven with adrenalectomy alone (D). RESULTS: Groups A and B showed significant reduction in fertility, and also bilaterally in difference between testicular and abdominal temperatures, epididymal spermatozoal content and motility, and testicular weight at 12 weeks post-surgery. All values were nearly identical in groups A and B. CONCLUSIONS: Since left adrenalectomy did not ameliorate the effects of varicocele, it appears that retrograde flow of adrenal metabolite(s) may not be responsible for the harmful effect of (left) varicocele on fertility.

Adrenal Glands↗
PubMed1993

Kinetics of drug action in disease states. XLI. Effect of adrenalectomy on the hypnotic activity of phenobarbital, the neurotoxicity of theophylline and pain sensitivity in rats.

The purpose of this investigation was to determine the effects of adrenalectomy and adrenalectomy with corticosterone replacement on pain sensitivity and on the pharmacodynamics of a central nervous system depressant, phenobarbital, and a central nervous system stimulant, theophylline. Male Sprague-Dawley rats, bilaterally adrenalectomized, were maintained on normal saline solution or normal saline solution with corticosterone, 160 micrograms/ml, as drinking water for 9 or 11 days. Sham-operated animals served as normal controls. They were then tested for pain sensitivity by the tail-flick method. Phenobarbital or theophylline was infused i.v. slowly until the onset of loss of righting reflex or of maximal seizures, respectively. Samples of cerebrospinal fluid (CSF), blood (for serum) and the brain were obtained at that time and assayed for phenobarbital or theophylline by high-performance liquid chromatography. Compared to the controls, the adrenalectomized rats required a smaller dose and lower concentrations of phenobarbital in serum, brain and CSF (12% decrease) to produce loss of righting reflex. The opposite effect was observed in adrenalectomized rats supplemented with corticosterone. Adrenalectomy had no apparent effect on the dose and the serum, brain and CSF concentrations of theophylline at the onset of maximal seizures whereas adrenalectomized, corticosterone-supplemented animals required a larger dose and higher concentrations (17% increase in CSF) of theophylline than controls to produce seizures. Tail-flick latency was slightly (19%) but statistically significantly reduced in adrenalectomized rats and lengthened (18%) in adrenalectomized, corticosterone-supplemented animals.

Adrenalectomy↗
PubMed1995

Effects of bilateral adrenalectomy on initiation of fur growth cycles in the deer mouse (Peromyscus maniculatus).

The objectives of this study were to determine the effects of bilateral adrenalectomy on the initiation of hair growth in the deer mouse and the duration of the actively growing phase of the hair growth cycle (anagen). Bilateral adrenalectomy plus deoxycorticosterone supplementation of adult deer mice resulted in the onset of hair growth 4 days earlier than in sham-operated mice supplemented with deoxycorticosterone. The duration of hair growth (anagen), based on guard hair measurements, was estimated to be approximately 12 days in both groups. As was expected for this species, the portion of the sheared test area in which new hair grew was incomplete in all control mice. In contrast, all adrenalectomized mice had hair growth over the entire sheared area. This suggests that normal, incomplete pelage replacement in adults was abolished and that adrenalectomy had a systemic effect, causing a greater number of hair follicles to become activated concurrently. These findings support the hypothesis that adrenal hormones exert an inhibitory effect on the induction of anagen and may be part of the mechanism controlling the onset of hair growth cycles.

Adrenal Glands↗
PubMedDate not supplied

Laparoscopic adrenalectomy.

Traditional adrenalectomy usually required long incisions that causes considerable pain and morbidity. Adrenal tumours are ideal for laparoscopic removal because they are usually small, benign and no reconstruction is needed. Various laparoscopic approaches have been described. Early reports of laparoscopic adrenalectomy described the lateral transabdominal approach. The extraperitoneal approach needed an artificial space to work. Our unit used the anterior transabdominal approach because it provided clear anatomical landmarks and early control of adrenal veins is possible. Initial results from various authors showed encouraging results. Although the operative time is longer the time to resume diet and mobilization is shorter when compared to open surgery. As experience gained, the operative time can be shortened. We believed that with proper preoperative assessment and preparation, laparoscopic adrenalectomy is safe and feasible.

Abdomen↗
PubMed1996

[Endoscopic, extraperitoneal adrenalectomy--an expansion of the approach to the adrenal gland].

From March 1994 to march 1996 we performed extraperitoneal adrenalectomy in 25 patients with adrenal gland tumors; three of these patients underwent bilateral adrenalectomy. Endoscopic extraperitoneal adrenalectomy was successful in 22 patients. No postoperative complications were observed, median postoperative hospital stay was 5 days (2-12). The described approach produces rapid recovery and creates less postoperative pain.

Adenoma↗
PubMed1996

Laparoscopic adrenalectomy.

Fifteen patients with benign adrenal tumors underwent laparoscopic adrenalectomy for the following indications: six pheochromocytomas, four adenomas, two Cushing's syndromes, one hematoma, one myolipoma, and one Conn's syndrome. Fourteen of 15 procedures were completed laparoscopically. The average blood loss was 300 ml; the mean operative time was 150 min. In the hands of a laparoscopically experienced surgeon, laparoscopic adrenalectomy is a safe and effective procedure involving minimal morbidity. With the accepted indications for removal of benign adrenal tumors, laparoscopic adrenalectomy is our therapy of choice.

Adrenal Gland Neoplasms↗
PubMed1996

Technique of transperitoneal laparoscopic adrenalectomy.

Adrenalectomy can be successfully and safely carried out with a laparoscopic technique, using standard instrumentation via a transperitoneal approach. We describe five tasks to be completed by the surgeon: (a) generation of pneumoperitoneum and port placement, (b) exposure of the adrenal gland, (c) dissection of the adrenal gland, (d) clipping of the adrenal vein, and (e) removal of the adrenal gland and fascial closure of port sites. Each step is described in detail for right and left adrenalectomy. Laparoscopic adrenalectomy is advocated on the same grounds as other laparoscopic procedure, namely, decreased postoperative pain and ileus, a better cosmetic result, decreased hospital stay, and a shorter convalescent period. Some other advantages of the laparoscopic technique are: minimal extent of dissection and excellent visibility and exposure of the adrenal gland.

Adrenal Gland Neoplasms↗
PubMed1997

Laparoscopic adrenalectomy for solitary metachronous contralateral adrenal metastasis from renal cell carcinoma.

PURPOSE: We report our experience with laparoscopic adrenalectomy for malignant adrenal disease. MATERIALS AND METHODS: Between June 1995 and January 1996, 2 patients with a solitary metachronous contralateral adrenal metastasis from renal cell cancer were evaluated. Both patients had undergone radical nephrectomy for localized renal cancer 5 years previously. Laparoscopic transperitoneal adrenalectomy was performed. RESULTS: The laparoscopic procedures required 2.5 and 4.3 hours. Hospital stay was 3 and 4 days. The specimens weighed 98 and 81 gm. All surgical margins were free of metastatic clear cell cancer. Both patients were begun on prednisone and fludrocortisone replacement therapy. One patient experienced an increase in creatinine, which has since stabilized at 3.0 mg/dl. Neither patient had recurrent cancer at 11 and 16 months of followup. CONCLUSIONS: Laparoscopic adrenalectomy for metastatic renal cell cancer was performed successfully in 2 patients. However, the short-term benefits to the patient of earlier ambulation, decreased pain, minimal incisions and shortened convalescence must be weighted against the as yet unknown long-term (5 years) results.

Adrenal Gland Neoplasms↗
PubMed1997

[Endoscopic retroperitoneal adrenalectomy: a surgical improvement].

OBJECTIVE: Evaluation of endoscopic retroperitoneal adrenalectomy in patients with adrenal tumours less than 6 cm in diameter. DESIGN: Retrospective analysis. SETTING: University Hospital Rotterdam-Dijkzigt, Department of General Surgery, Rotterdam, the Netherlands. METHOD: Analysis of per- and postoperative data on 19 patients subjected to endoscopic retroperitoneal adrenalectomy; 3 patients had bilateral surgery. RESULTS: Twenty adrenal tumours in 17 patients were successfully removed endoscopically. Conversion to lumbotomy was necessary in the two other cases. Median operative time was 85 min (range: 50-120). Median blood loss was 50 ml (10-400). Median postoperative hospital stay was 4 days (2-14). CONCLUSION: Endoscopic retroperitoneal adrenalectomy is associated with minimal morbidity and therefore valuable in patients with adrenal tumours smaller than 6 cm in diameter.

Adrenal Gland Neoplasms↗
PubMed1997

[Initial experience with laparoscopic adrenalectomy].

We present the first experience with laparoscopic adrenalectomy, which was in Slovakia introduced to the surgical practice on March 3, 1996. We analyse first seven patients who underwent completed laparoscopic adrenalectomy (five leftsided, two right-sided). Four patients had cortex adenoma (clinically 2 incidentalomas and 2 Cishing syndroma), three patients had cortex hyperplasia (clinically Conn syndroma). Average duration of operation was 120 minutes, there were no postoperative complications. Average postoperative hospital stay was 5 days. Our initial experiences are comparable with that of surgical departments which has more than two-years experiences. Laparoscopic adrenalectomy is a perfect method for the small adrenal tumors and it is better than traditional transabdominal approach.

Adrenalectomy↗
PubMed1998

Is adrenalectomy part of radical nephrectomy?

Standard radical nephrectomy entails en bloc removal of the kidney together with Gerota's fascia and the ipsilateral adrenal. Thanks to the refinement of imaging techniques (ultrasound, CT and MRI), smaller tumors are being diagnosed. In addition, direct extension to the adrenal gland or adrenal metastasis can be detected in most cases. This is why several authors reserve adrenalectomy for large and/or upper pole tumors or abnormal appearing glands on preoperative CT-scan. However, preoperative diagnosis is not always accurate. Furthermore, micrometastatic adrenal invasion at the time of nephrectomy and late recurrences in the persistent adrenal have been documented, so that partisans of adrenalectomy only spare the adrenal in exceptional cases. The authors have reviewed several series in the litterature as well as there own, and conclude that ipsilateral adrenalectomy can be omitted for small middle- or lower pole tumors when the adrenal appears normal on CT and during the surgical intervention.

Adrenal Gland Neoplasms↗
PubMed1998

Laparoscopic adrenalectomy: advantages of an atraumatic suction grasper.

Laparoscopic adrenalectomy still presents some technical problems. The impossibility of directly grasping the gland is the main difficulty. To overcome this problem, we have begun to use an atraumatic suction grasper. From September 1995 to December 1997, 15 laparoscopic adrenalectomies were performed. Group 1 comprised 8 patients operated on without the atraumatic suction grasper; group 2 consisted of 7 patients who underwent a laparoscopic adrenalectomy with the use of this new device. The surgical technique with the use of an atraumatic suction grasper is described. No significant difference was noted between the two groups except in the operative time, which was reduced in group 2, and in the surgeon's comfort. The reported advantages are a direct grasp of the adrenal gland without the risk of squeezing, rupture, or bleeding; a better exposure of the adrenal vessels; and shorter operating time.

Adrenal Gland Neoplasms↗
PubMed1998

[Video laparoscopic adrenalectomy].

BACKGROUND: The authors describe the surgical technique for right and left adrenalectomy and the per- and postoperative course of the patients. METHODS: Twenty-seven laparoscopic adrenalectomies were performed between November 1992 and February 1996: there were 18 women and 9 men ranging in age from 31 to 70 years (mean 50.8 years); the surgical procedure was a lateral decubitus transperitoneal flank approach in 26 patients, and a retroperitoneal approach in one. RESULTS: Twelve right and 15 left glands were removed. Adrenal diseases were primary aldosteronism in 20 patients, non-functional adenoma in 3 patients, 2 Cushing's syndrome, adrenal cyst in one and incidentaloma in one. Mean adrenal gland size was 2.6 cm (range 0.5 to 8 cm). Five patients (18.5%), were converted to laparotomy, for dissection problems in 4 and failure to locate the left adrenal gland in one. The mean anesthesia time was 205.7 min and the mean surgical time 141.2 min. Surgical morbidity was one adrenal vein injury sectioned close to the vena cava: the hemorrhage was controlled by laparoscopic suturing without conversion. No mortality occurred and postoperative morbidity was one minor chest infection. The mean postoperative stay in hospital was 3.7 days (range 2.8) for the non converted patients. Laparoscopic adrenal gland removal is safe and offers fast recovery and short hospital stay. Laparoscopic adrenalectomy combines the advantages of both the conventional anterior and posterior approach. CONCLUSIONS: Personal experience of laparoscopic adrenal gland removal is described: a safe adrenal vascular control and gland dissection were performed and the length of operation and postoperative course carefully presented.

Adrenalectomy↗
PubMed1998

[Adrenalectomy and radical nephrectomy due to renal carcinoma].

BACKGROUND: Surgery remains the only effective treatment for renal carcinoma. According the current surgical procedure, both the neoplastic kidney with its perirenal tissue and the Gerota fascia with adrenal gland must be removed. In the last years, the utility of routine adrenalectomy for kidney cancer surgery has been questioned and some authors now recommend this procedure just in selected cases. METHODS: In order to provide a contribution to this debate, 350 cases of nephrectomy after renal carcinoma have been reviewed. In all, 185 adrenalectomy have been performed and neoplastic involvement of adrenal gland has been identified just in 9 cases (4.9%), suggesting a rarity of tumor progression to adrenal gland at the time of surgery. RESULTS: Moreover, neoplastic involvement of adrenal gland has been shown in just 3 cases at preoperatively CT scan. CONCLUSIONS: The conclusion is drawn that adrenal gland may be retained in surgery for radical nephrectomy after renal carcinoma. Adrenalectomy may be recommended in doubtful cases, especially in upper pole localization and in large tumours.

Adrenalectomy↗