Introduction: The advantages and benefits of laparoscopic adrenalectomy (LA) are widely accepted. Since 1992, this approach appeared the gold standard to treat benign adrenal disorders. Nevertheless the patients need a strict assistance in the peroperative period. Methods: We retrospectively reviewed our series of LA for pheochromocytoma. Alphablockage associated to a beta-blockage for concomitant tachycardia was administered to all patients. LA was performed transperitoneally in lateral flank position. Results: Between March 1995 and December 2009 we performed 355 LA in 343 patients. Fifty-four LA (24 right (48%), 22 left (44%) and 4 bilateral LA (8%)) were performed for pheochromocytoma in 50 patients (25 males and 25 females, mean age 52.7 years old). The preoperative diagnosis was occasional in 23 patients, while related to clinical symptoms in 27. Tachycardia was associated in 18% (9/50) of patients. There was no laparotomic conversion. The mean operative time was 95.6 (45-210) minutes: left 92.3 minutes, right 89.7 minutes and bilateral 205 minutes. The mean lesion size was 3.98 cm (1.5-9 cm). Postoperative hystopatological findings were 46 pheochromocytomas (85.2%), 5 medullar hyperplasias (9.3%) and 3 adenomas (5.5%). There were four intraoperative complications (8%): three cases of hypertensive crisis, one case of acute pulmonary oedema. The postoperative morbidity was 14% (7/50): two cases of hypertensive crisis resolved pharmacologically; three cases of respiratory insufficiency resolved with c-PAP and O2-therapy; two cases of development of bacterial pneumonia, resolved with association of antibiotics. There was no postoperative mortality. During follow-up, 38 patients (76%) report full recovery of the hypertensive status; 9 patients (18%) improved their hypertensive status reducing pharmacological therapy; in 3 cases (6%) blood pressure values remain over physiological rates as before LA. Postoperative titer of Chromogranine A, urinay metanephrines and plasmatic catecholamines ranged among normal values in 47 patients (93%). Conclusion: LA is a safe and effective surgical technique for the treatment of functional adrenal pathologies like pheochromocytoma. In order to obtain good results a strict cooperation between endocrinological, anesthesiological and surgical team in Centers with wide expertise in endocrine and advanced laparoscopic surgery is mandatory.
Lesson learned from laparoscopic adrenalectomy for pheocromocytoma
VISCONTI, DIEGO;MORINO, Mario
2011-01-01
Abstract
Introduction: The advantages and benefits of laparoscopic adrenalectomy (LA) are widely accepted. Since 1992, this approach appeared the gold standard to treat benign adrenal disorders. Nevertheless the patients need a strict assistance in the peroperative period. Methods: We retrospectively reviewed our series of LA for pheochromocytoma. Alphablockage associated to a beta-blockage for concomitant tachycardia was administered to all patients. LA was performed transperitoneally in lateral flank position. Results: Between March 1995 and December 2009 we performed 355 LA in 343 patients. Fifty-four LA (24 right (48%), 22 left (44%) and 4 bilateral LA (8%)) were performed for pheochromocytoma in 50 patients (25 males and 25 females, mean age 52.7 years old). The preoperative diagnosis was occasional in 23 patients, while related to clinical symptoms in 27. Tachycardia was associated in 18% (9/50) of patients. There was no laparotomic conversion. The mean operative time was 95.6 (45-210) minutes: left 92.3 minutes, right 89.7 minutes and bilateral 205 minutes. The mean lesion size was 3.98 cm (1.5-9 cm). Postoperative hystopatological findings were 46 pheochromocytomas (85.2%), 5 medullar hyperplasias (9.3%) and 3 adenomas (5.5%). There were four intraoperative complications (8%): three cases of hypertensive crisis, one case of acute pulmonary oedema. The postoperative morbidity was 14% (7/50): two cases of hypertensive crisis resolved pharmacologically; three cases of respiratory insufficiency resolved with c-PAP and O2-therapy; two cases of development of bacterial pneumonia, resolved with association of antibiotics. There was no postoperative mortality. During follow-up, 38 patients (76%) report full recovery of the hypertensive status; 9 patients (18%) improved their hypertensive status reducing pharmacological therapy; in 3 cases (6%) blood pressure values remain over physiological rates as before LA. Postoperative titer of Chromogranine A, urinay metanephrines and plasmatic catecholamines ranged among normal values in 47 patients (93%). Conclusion: LA is a safe and effective surgical technique for the treatment of functional adrenal pathologies like pheochromocytoma. In order to obtain good results a strict cooperation between endocrinological, anesthesiological and surgical team in Centers with wide expertise in endocrine and advanced laparoscopic surgery is mandatory.
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