1211 DOES LAPAROENDOSCOPIC SINGLE-SITE ADRENALECTOMY INCREASE SURGICAL RISK IN PATIENTS WITH UNILATERAL PHEOCHROMOCYTOMA?; CASE CONTROL STUDY

Abstract

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy1 Apr 20111211 DOES LAPAROENDOSCOPIC SINGLE-SITE ADRENALECTOMY INCREASE SURGICAL RISK IN PATIENTS WITH UNILATERAL PHEOCHROMOCYTOMA?; CASE CONTROL STUDY Takahiro Maeda, Akira Miyajima, Eiji Kikuchi, Masanori Hasegawa, Takeo Kosaka, Ken Nakagawa, and Mototsugu Oya Takahiro MaedaTakahiro Maeda Tokyo, Japan More articles by this author , Akira MiyajimaAkira Miyajima Tokyo, Japan More articles by this author , Eiji KikuchiEiji Kikuchi Tokyo, Japan More articles by this author , Masanori HasegawaMasanori Hasegawa Tokyo, Japan More articles by this author , Takeo KosakaTakeo Kosaka Tokyo, Japan More articles by this author , Ken NakagawaKen Nakagawa Tokyo, Japan More articles by this author , and Mototsugu OyaMototsugu Oya Tokyo, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.867AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We examined the safety of laparoendoscopic single-site adrenalectomy (LESS-A) for pheochromocytoma (PHE) and the benefits of LESS-A over conventional laparoscopic adrenalectomy (CL-A) in patients with PHE. METHODS We identified 92 and 35 consecutive patients who had been treated with CL-A and LESS-A between 2006 and 2010 at our institution. First, we evaluated the 35 consecutive patients in the LESS-A group, which included 10 cases of PHE, and compared the perioperative data and immediate surgical outcomes between the LESS-PHE and non-PHE patients. Next, from this cohort, we selected patients with PHE who underwent both LESS-A (cases, n=10) and CL-A (controls, n=10) in order to conduct a matched case-control study to compare hemodynamic parameters and surgical outcomes. The 10 control patients were matched to the LESS cases with respect to sex, age, body mass index, tumor laterality and size, and the level of preoperative catecholamines. RESULTS Significant differences between LESS-A for PHE and non-PHE in terms of tumor size 36.6±4.7 versus 22.2±3.2 mm (p=0.007), operative time 156.1±12.7 versus 129.0±6.2 minutes (p=0.043), and intraoperative total fluids 2571±208 versus 1389±93 ml (p=0.001) were observed. However, the estimated blood loss, number of days to first postoperative oral feeding, and postoperative hospital stay were similar between the two groups. One of the 10 LESS-A for PHE patients required conversion to CL-A due to stiff adhesions, however, there were no significant differences in operation time, estimated blood loss, or postoperative recovery during the operation in patients with PHE between the CL-A and LESS-A groups. There was no significant difference in the highest intraoperative blood pressure (180.7±8.4 in CL group versus 162.7±8.3 mmHg in LESS group, p=0.149). The frequency of hypertensive episodes, including SBP ≥200 mmHg or ≥30% above the baseline, was not significantly different (7 cases in CL versus 5 cases in LESS). Seven patients in the LESS-group experienced intraoperative hypotension (SBP <80 mmHg), which was similar to the 6 patients in the CL-group. Neither the highest nor lowest heart rate was different between these two groups. There were no treatment-resistant hemodynamic changes that resulted in any serious consequences. CONCLUSIONS We conclude the safety of LESS-A for PHE is comparative with that of CL-A. With appropriate preoperative and intraoperative hemodynamic control together with an experienced surgeon, LESS-A should be considered a treatment choice for resection of PHE. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e486 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Takahiro Maeda Tokyo, Japan More articles by this author Akira Miyajima Tokyo, Japan More articles by this author Eiji Kikuchi Tokyo, Japan More articles by this author Masanori Hasegawa Tokyo, Japan More articles by this author Takeo Kosaka Tokyo, Japan More articles by this author Ken Nakagawa Tokyo, Japan More articles by this author Mototsugu Oya Tokyo, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...