medigraphic.com

2014, Number 3

<< Back Next >>

Rev Cuba Endoc 2014; 25 (3)

Learnt lessons from laparoscopic adrenalectomy

Torres PR, Turcios TS, León CL, Nodal OJ, Morera PM

Language: Spanish
References: 32
Page: 216-230
PDF size: 293.20 Kb.


ABSTRACT

Introduction: laparoscopic adrenalectomy has turned into the standard treatment of functional and non-functional benign diseases in the adrenal glands. This study was aimed at evaluating the results of the laparoscopic adrenalectomy in the National Center of Minimal Access Surgery.
Methods: a descriptive, observational and prospective study was conducted from February 2001 through September 2011 in which laparoscopic adrenalectomies performed to 36 patients. The preoperative diagnostic assessment was made at the National Institute of Endocrinology and the surgical treatment was prescribed in the National Center of Minimal Access Surgery, both based on the multicenter and multidisciplinary management. The preoperative diagnosis-related parameters, the surgical procedure details and the postoperative care were all statistically analyzed.
Results: left adrenal gland was removed from 18 patients, the right one was removed in 13 and both glands in 5 patients. 75.6% of surgeries were performed in patients with functioning disease, endogenous hypercortisolism (25), primary hyperaldosteronism (3) and pheochromocytoma (3). Prescriptions for incidentalomas were less frequent. The mean age of patients was 41 years (range of 21-65); the average surgical time was 210 minutes (range of 90-360); the average intraoperative bleeding was 84mL (range of 10-400); the average size of tumor was 4.6 cm (range of 0.9-8.5). There were two conversions which are statistically correlated with over 5 cm tumors (p= 0.046). Intraoperative complications were unreported whereas surgical wound sepsis affected 2 patients. Mortality was null.
Conclusions: the multicenter and multidisciplinary approach, based on experiences in endocrine management and laparoscopic access of two Cuban reference centers, allowed achieving excellent functional results, minimal perioperative morbidity and null mortality.


REFERENCES

  1. Gagner M, Lacroix A, Bolté E. Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med. 1992;327:1033.

  2. Hall DW, Raman JD. Has Laparoscopy Impacted the Indications for Adrenalectomy? Curr Urol Rep. 2010 ;11:132-7.

  3. Ruiz J. Evolución histórica de la cirugía endoscópica. En: Ruiz J, Torres R, Martínez MA, Fernández A, Pascual H. Cirugía Endoscópica. Fundamentos y aplicaciones. La Habana: Editorial Científico Técnica; 2000. p. 19-22 .

  4. Fernández-Cruz L, Benarroch G, Astudillo E. Technical aspects of adrenalectomy via operative laparoscopy. Surg Endosc. 1994 ;8:1348.

  5. Gagner M. Laparoscopic adrenalectomy. Surg Clin North Am. 1996;76:523

  6. Pietrabissa A, Cuschieri A, Carobbi A, Boggui U, Vistoli F, Mosca F. Safety of adrenal vein ligation during endoscopic adrenalectomy. A technical note. Surg Endosc. 1999;13:298-302.

  7. Munver R, Yates J. Diagnosis and Surgical Management for Primary Hyperaldosteronism. Curr Urol Rep. 2010 ;11:51-7.

  8. Walz M, Alesina P, Wenger F, Deligiannis A, Szuczik E, Petersenn S. Posterior retroperitoneoscópica adrenalectomy: results of 560 procedures in 520 patients. Surgery. 2006;140:943-50.

  9. Chiu A. Laparoscopic retroperitoneal adrenalectomy: clinical experience with 120 consecutive cases. Asian J Surg. 2003;26:139-44.

  10. Walz MK, Peitgen K, Hoermann R, Giebler RM, Mann K, Eigler FW. Posterior retroperitoneoscopy as a new minimally invasive approach for adrenalectomy: results of 30 adrenalectomies in 27 patients. World J Surg. 1996;20:769-74

  11. Porterfield JR, Thompson GB, Young WF, Chow JT, Fryrear RS, van Heerden JA, et al. Surgery for Cushing’s Syndrome: An Historical Review and Recent Ten-year Experience. World J Surg. 2008 ;32:659-77.

  12. Alberda WJ, van Eijck CHJ, Feelders RA, Kazemier G, de Herder W, Burger JW. Endoscopic bilateral adrenalectomy in patients with ectopic Cushing’s syndrome. Surg Endosc. 2012;26:1140-5 .

  13. Smith PW, Turza KC, Carter CO, Vance ML, Laws ER, Hanks JB. Bilateral adrenalectomy for refractory Cushing disease: a safe and definitive therapy. J Am Coll Surg. 2009;208:1059-64.

  14. Chow JT, Thompson GB, Grant CS, Farley DR, Richards ML, Young WF Jr. Bilateral laparoscopic adrenalectomy for corticotrophin-dependent Cushing’s syndrome: a review of the Mayo Clinic experience. Clin Endocrinol (Oxf). 2008 ;68:513-9.

  15. Takata MC, Kebebew E, Clark OH, Duh QY. Laparoscopic bilateral adrenalectomy: results for 30 consecutive cases. Surg Endosc. 2008;22:202-7.

  16. Gil-Cárdenas A, Herrera MF, Díaz-Polanco A, Rios JM, Pantoja JP. Nelson’s syndrome after bilateral adrenalectomy for Cushing’s disease. Surgery. 2007;141:147-52.

  17. Iacobone M, Albiger N, Scaroni C, Mantero F, Fassina A, Viel G, Frego M, Favia G. The Role of Unilateral Adrenalectomy in ACTH-Independent Macronodular Adrenal Hyperplasia (AIMAH). World J Surg. 2008;32:882-9 .

  18. Nehs MA, Ruan DT. Minimally invasive adrenal surgery: an update. Current Opinion in Endocrinology, Diabetes and Obesity. 2011 ;18:193-7.

  19. Castillo OA, Vitagliano G, Secin FP, Kerkebe M, Arellano L. Laparoscopic adrenalectomy for adrenal masses: does size matter? Urology. 2008;71:1138-41.

  20. Kercher KW, Novitsky YW, Park A, Matthews BD, Litwin DE, Heniford BT. Laparoscopic curative resection of pheochromocytomas. Ann Surg. 2005;241:919-26.

  21. Toniato A, Boschin IM, Opocher G, Guolo A, Pelizzo M, Mantero F. Is the laparoscopic adrenalectomy for pheochromocytoma the best treatment? Surgery. 2007;141:723-7.

  22. Perry KA, El Youssef R, Pham TH, Sheppard BC. Laparoscopic adrenalectomy for large unilateral pheochromocytoma: experience in a large academic medical center. Surg Endosc. 2010 ;24:1462-7.

  23. Parnaby CN, Chong PS, Chisholm L, FarrowJ, Connell JM, O’ Dwyer PJ. The role of laparoscopic adrenalectomy for adrenal tumours of 6 cm or greater. Surg Endosc. 2008;22:617-21.

  24. Tsuru N, Suzuki K, Ushiyama T, et al. Laparoscopic adrenalectomy for large adrenal tumors. J Endourol. 2005;19:537-40.

  25. Walz MK, Petersenn S, Koch JA, Mann K, Neumann HP, Schmid KW. Endoscopic treatment of large primary adrenal tumors. Br J Surg. 2005;92:719-23.

  26. Wilhelm SM, Prinz RA, Barbu AM, Onders RP, Solorzano CC. Analysis of large versus small pheochromocytomas: operative approaches and patient outcomes. Surgery. 2006;140:553-9.

  27. James JS, Raman JD, Del Pizzo JJ. Laparoscopic Adrenalectomy for Large Adrenal Masses. Current Urology Reports. 2008;9:73-9.

  28. Shen ZJ, Chen SW, Wang S, Jin XD, Chen J, Zhu Y, Zhang RM. Predictive factors for open conversion of laparoscopic adrenalectomy: a 13-year review of 456 cases. J Endourol. 2007 ;21:1333-7.

  29. Bergamini C, Martel J, Tozzi F, Valeri A. Complications in laparoscopic adrenalectomy: the value of experience. Surg Endosc. 2011;25:3845-51.

  30. Gupta PK, Natarajan B, Pallati PK, Gupta H, Sainath J, Fitzgibbons RJ. Outcomes after laparoscopic adrenalectomy. Surg Endosc. 2011;25:784-94 .

  31. Tessier DJ, Iglesias R, Chapman WC, Kercher K, Matthews BD, Gorden DL, et al. Previously unreported high-grade complications of adrenalectomy. Surg Endosc. 2009 ;23:97-102.

  32. Strebel RT, Müntener M, Sulser T. Intraoperative complications of laparoscopic adrenalectomy. World J Urol. 2008 ;26:555-60.




2020     |     www.medigraphic.com