Cases Of Laparoscopic Adrenalectomy Research Articles

Laparoscopic adrenalectomy for adrenal myelolipoma (2 clinical cases)

Adrenal myelolipoma is a rare benign tumor with characteristic histological and radiological picture. Significant tumor size, suspicion of malignancy, and danger of bleeding are indications for laparoscopic adrenalectomy. In this article, we present 2 clinical cases of laparoscopic adrenalectomy for adrenal myelolipoma.

LAPAROSCOPIC ADRENALECTOMY IN PEDIATRIC PATIENTS - A REPORT OF 2 CASES.

AbstractReporting on the laparoscopic technique for adrenal disease in children and adolescents has been limited. Laparoscopic adrenalectomy are been performed in selected patients in centers with advanced laparoscopic expertise. Here we report two cases of laparoscopic adrenalectomy done for functional adrenal tumors in pediatric patients.

Adrenalectomía laparoscópica en patología benigna

Laparoscopic adrenalectomy in benign disease Introduction: Nowadays the laparoscopic approach is the procedure of choice in adrenal diseases, except malignant adrenal tumors. Methods: A descriptive and retrospective study of the first 55 cases of laparoscopic adrenalectomy performed in our hospital between 1998 and 2011, we reviewed the short and long term results. Results: We had one case of conversion to open surgery in a patient with accidental section of the right renal vein. One case of reoperation due to hepatic injury. One case of postoperative mortality in a 71 year old woman with high anesthetic risk operated for Cushings syndrome. Other complications were a case of hydropneumothorax and three cases of abdominal wall hematoma in site of laparoscopic trocar. In the follow up at 45 months all the patients remain asymptomatic, except one with ectopic Cushings syndro- me due to bronchial carcinoid. Conclusions: Laparoscopic adrenalectomy has good results and is an easily reproducible procedure, but must be performed by expert laparoscopic surgeons with a good knowledge of adrenal anatomy and experience in open surgery which allow them to solve the complications that may arise during the laparoscopic procedure.

V868 LAPAROENDOSCOPIC SINGLE-SITE NEPHROURETERECTOMY

side. After identifying renal vein, adrenal vein is ligated. Following procedures are the same as on the right side. The camera scope is replaced to 5mm and inserted into 5mm working port, and 12mm port is used for delivering specimen. Drain is not inserted. RESULTS: There was significant improvement in average operation time(90 vs. 53min, p 0.003) and decrease in estimated blood loss(130 vs, 50mL, p 0.001) of the latter 33 unilateral laparoscopic adrenalectomy cases compared to the prior 33 cases. CONCLUSIONS: With the knowledge of anatomical structures near the adrenal glands, the surgical techniques introduced here in this video clip will help the surgeon with little experience on adrenalectomy to overcome the learning curve.

Laparoscopic Adrenalectomy in Giant Masses

Laparoscopic adrenalectomy is considered the treatment of choice in the surgical management of the most majority of the adrenal diseases. Nevertheless, one of the much discussed topics is the dimensional cut-off for the laparoscopic treatment and it is not clear if laparoscopy should be used in large adrenal masses.Introduction. Laparoscopic adrenalectomy is the goal standard in benign adrenal masses smaller than 6 cm, while its advantages in masses larger than this cut-off and in malignant lesions is still discussed. We present six cases of laparoscopic adrenalectomy since November 2008 for masses between 7 and 15 cm; 4 men and 2 women. 3 right and 3 left. A complete adrenal endocrinological evaluation demonstrated that the lesions were not secreting tumors. All patients were studied with CT scan.The technique was performed using a flank approach with a 45° tilt. We used 5 trocars in patients who had the masses on the right side, and 4 in those who had the lesions on the left side. After creating an adequate pneumoperitoneum through an open access, the posterior peritoneum cutting, mobilization of the colon, medial dissection of the adrenal gland, and ligation of the main adrenal vein were performed. The adrenal gland was carefully dissected by Ultracision. The mass was extracted by endobag through an additional subcostal port. The mean operative time was 120 minutes. Blood loss was about 50 cc. The drainage was removed on day 2 after surgery and the patient was discharged on day 3. No postoperative complication occurred. The anatomopathologic exam gave evidence of myelolipoma and hemorrhagic cyst. The benefits of the laparoscopic approach are widely demonstrated and consist of a shorter hospital stay, reduced morbility, decreased analgesic requirement, and reduced intraoperative blood loss. One of the most discussed topics is the dimensional cut-off and it is not clear if the laparoscopy approach should be used in large adrenal masses (considering the longer operative time and increasing blood loss). Many surgeons performed laparoscopic adrenalectomy for masses of up to 13 cm, thus demonstrating that this procedure is safe and effective. A limitation of laparoscopic approach for adrenal giant masses is the increased risk to treat an adrenal cortical carcinoma. Our experience, supported by the literature, demonstrates that the laparoscopic adrenalectomy is a feasible and effective surgical technique also in the case of giant masses. Preoperative diagnosis has a predominant role to determine the contraindication of this technique (invasive adrenal carcinoma).

Adrenalectomía laparoscópica por patología maligna

There is general agreement on the suitability of the laparoscopic approach for benign adrenal lesions against open procedures because of the efficacy and less morbidity. For suspected adrenal malignancies laparoscopic use is controversial. We report our experience in 6 cases of laparoscopic adrenalectomy in patients with the suspicion of adrenal malignancy confined in the gland. In medium a follow up of 24 months (range 12 to 48 months) we observed no recurrences. We concluded that in a suspected adrenal malignancy organ confined laparoscopic adrenalectomy presents the advantage compared with open surgery of reduced morbidity and similar results in the follow up of the patient.

Adrenalectomia laparoscópica: análise de 11 pacientes

OBJETIVO: Analisar a experiência inicial da Divisão de Urologia do HCFMRP-USP na adrenalectomia transperitoneal videolaparoscópica. MÉTODOS: Análise retrospectiva de 11 casos de adrenalectomia transperitoneal laparoscópica realizados de fevereiro de 1999 a março de 2003 sendo 3 em homens( 27%) e 8 em mulheres (73%), idade média de 40,2 ± 13,1 anos. Os pacientes apresentavam os diagnósticos seguintes: adenoma - 5, síndrome de Cushing - 3, feocromocitoma - 1, hiperaldestorismo - 1 e síndrome de Carney - 1. RESULTADOS: A cirurgia foi bilateral em 05 pacientes (45,4%) e unilateral em 06 pacientes (54,6 %), destes 04 à direita (36,4%) e 02 à esquerda (18,2%). O tempo médio de internação foi de 3,6 ± 1,1 dias, o tempo médio de cirurgia foi de 220,5 ± 103,7 minutos e a taxa de conversão foi de 18,2%. CONCLUSÃO: Os resultados apresentados são similares aos relatados pela literatura, demonstrando que a adrenalectomia videolaparoscópia pode ser realizada de maneira segura e eficiente com benefícios: tempo cirúrgico aceitável, rápida recuperação pós-operatória e alta precoce.

A Clinical Review of Initial 20 Cases of Laparoscopic Adrenalectomy

A Clinical Review of Initial 20 Cases of Laparoscopic Adrenalectomy

Laparoscopic Right Adrenalectomy: Report of Two Cases

Biochemical testing and imaging studies afford the surgeon many options in the evaluation of a patient with an adrenal mass. The development of a high resolution videoendoscopy system has made adrenal surgery one of the most applicable procedures for the laparoscopic approach. We report two cases of laparoscopic adrenalectomy through the lateral transabdominal approach. Case 1 is a 16-year-old male with pheochromocytoma of the fight adrenal gland; case 2 is a 35-year-old male with myelolipoma of the right adrenal gland- Both conditions were diagnosed by pathology. Both patients recovered uneventfully and were discharged 5 days postoperatively. We present the results of our laparoscopic right adrenalectomy and a review of the literature.

Laparoscopic adrenalectomy for solitary metachronous adrenal metastasis from lung cancer: Report of a case

We report herein the case of a 69-year-old man who underwent laparoscopic adrenalectomy for a solitary adrenal metastasis 10 months after a left lower lobectomy for T2N1M0 lung cancer. A 30 x 20 mm tumor was found in the left adrenal gland, and dissected using an ultrasonically activated scalpel. Histological examination revealed metastatic squamous cell carcinoma. The patient recovered uneventfully and his condition is now stable 18 months after the second operation, with no evidence of local recurrence or metastatic disease. Although laparoscopic resection for malignant adrenal tumors is still controversial, we consider that laparoscopic adrenalectomy may be an optional treatment for metastatic adrenal tumors, provided the tumor is solitary, small in size, and well-localized. To our knowledge, only 14 cases of laparoscopic adrenalectomy for malignant tumors have been reported to date; however, this is the first case of successful laparoscopic adrenalectomy for a metastasis from lung cancer.

Laparoscopic Adrenalectomy: Comparison with Open Adrenalectomy

The results of the first 6 cases of laparoscopic adrenalectomy were compared with the most recent 11 consecutive cases of traditional open adrenalectomy for the treatment of benign adrenal tumor. In both groups, all the tumors were less than 4 cm in diameter and were removed successfully with no significant complications. The weight of the resected specimen and estimated blood loss were not significantly different in the two groups, and none of the patients needed a blood transfusion. Although laparoscopic adrenalectomy required a significantly longer operation time (median 230 min vs. 165 min for an open operation), the postoperative recovery estimated by the duration of restricted oral intake or walking was shorter, and the incidence of patients requiring postoperative parenteral analgesics was also significantly lower in laparoscopic adrenalectomy. Although the number of patients treated with the laparoscopic procedure is still small, these results suggest that laparoscopic adrenalectomy is a minimally invasive alternative to open adrenalectomy and, with further improvement of the operative technique and equipment, may become a more reliable and standard procedure for the treatment of benign adrenal tumor.