41 CELLULAR INTERMINGLING BETWEEN ADRENAL GLAND AND LIVER: AN INFREQUENT CAUSE OF INCOMPLETE RESECTION AT RIGHT ADRENALECTOMY

Abstract

You have accessJournal of UrologyAdrenal1 Apr 201341 CELLULAR INTERMINGLING BETWEEN ADRENAL GLAND AND LIVER: AN INFREQUENT CAUSE OF INCOMPLETE RESECTION AT RIGHT ADRENALECTOMY Mikio Sugimoto, Hiromi Hirama, Yushi Hayashida, Shinsuke Shibuya, Nobufumi Ueda, and Yoshiyuki Kakehi Mikio SugimotoMikio Sugimoto Kagawa, Japan More articles by this author , Hiromi HiramaHiromi Hirama Kagawa, Japan More articles by this author , Yushi HayashidaYushi Hayashida Kagawa, Japan More articles by this author , Shinsuke ShibuyaShinsuke Shibuya Kagawa, Japan More articles by this author , Nobufumi UedaNobufumi Ueda Kagawa, Japan More articles by this author , and Yoshiyuki KakehiYoshiyuki Kakehi Kagawa, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1417AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess the incidence of difficulty in complete dissection between the right adrenal gland and the liver at the time of laparoscopic surgery for adrenal tumor and to elucidate its cause histopathologically. METHODS Seventy-nine patients underwent laparoscopic adrenalectomy during the period between 2004 and 2011 at our institution. Affected glands were right in 36, left in 41 and bilateral in 2. Two reviewers independently assessed difficulty in dissection for the 36 non-edited video records of laparoscopic right adrenalectomy in the blind fashion. Twenty-seven records (10 males, 17 females, mean age: 51.8 years) were evaluable for the judgment of difficulty in dissection between the lower surface of the liver and the right adrenal gland. Adrenal tumor types were classified into 3 types according to location of tumor in the adrenal gland (A: tumor in the upper pole, B: tumor apart from the liver, C: multiple small tumor foci). On the other hand, gross and microscopic relationship between right adrenal gland and surface of the liver was investigated in 32 cadavers. RESULTS Incomplete resection of adrenal gland was found in 11 of 27 patients (40.7%). Difficulties in dissection due to adhesions between the liver and the adrenal gland were apparently recognized in 5 out of 27 patients (18.5 %). Pathological assessment for cadavers revealed that capsules between these two organs are partially fused in 10 out of 32 cases (31.3%). Histopathologically, intermingling of parenchymal cells (infiltration through the fibrous capsules) was observed in 9 cases (28.1%).Partial absence (between open arrows) of the intervening fibrous capsule between the liver and the right adrenal gland are observed as shown in the figure. Adreno cortical cells are growing into liver tissue (closed arrow)(Fugure). CONCLUSIONS The tight adhesion between lower surface of the liver and the adrenal gland due to intermingling of parenchymal cells of both organs is a major cause of incomplete resection of right adrenalectomy. Surgeons have to keep this fact in mind during right adrenalectomy for avoiding unnecessary adverse events. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e16 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mikio Sugimoto Kagawa, Japan More articles by this author Hiromi Hirama Kagawa, Japan More articles by this author Yushi Hayashida Kagawa, Japan More articles by this author Shinsuke Shibuya Kagawa, Japan More articles by this author Nobufumi Ueda Kagawa, Japan More articles by this author Yoshiyuki Kakehi Kagawa, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...