Anesthetic aspects of laparoscopic adrenalectomy for pheochromocytoma

Abstract

p HEOCHROMOCYTOMA is a catecholamine-producing tumor usually located in the adrenal gland. Signs and symptoms, which are related to the tumor's excessive secretion of norepinephrine and epinephrine, include hypertension, sweating, palpitations, headaches, and anxiety attacks. Pheochromocytoma is found in approximately 0.1% to 0.3% of patients undergoing evaluation for secondary causes of hypertension. 1 Early diagnosis and appropriate medical management of pheochromocytomas are of paramount importance. The perioperative mortality of unrecognized pheochromocytoma is high because of cerebrovascular, cardiovascular, and central nervous system catastrophes. Today, because of improvements in diagnosis, surgical techniques, perioperative monitoring, and modem antihypertensive drugs, perioperative mortality associated with pheochromocytoma surgery has been reduced to less than 1%. 2,3 With advances in surgical technology and more widespread experience in minimally invasive techniques, pheochromocytoma resection, a procedure that until recently had been considered suitable only for a conventional open approach, can now be performed laparoscopically. 4-6 Over the last several years, laparoscopic adrenalectomy for pheochromocytoma has been established as a safe and effective surgical procedure with many advantages over conventional open surgery. 5-7