You have accessJournal of UrologyAdrenal1 Apr 201343 HIGH PREOPERATIVE PLASMA EPINEPHRINE LEVEL IS A RISK FACTOR FOR INTRA OPERATIVE HYPERTENSION DURING LAPAROSCOPIC ADRENALECTOMY FOR PHEOCHROMOCYTOMA Junichi Inokuchi, Katsunori Tatsugami, Kentaro Kuroiwa, Akira Yokomizo, and Seiji Naito Junichi InokuchiJunichi Inokuchi Fukuoka, Japan More articles by this author , Katsunori TatsugamiKatsunori Tatsugami Fukuoka, Japan More articles by this author , Kentaro KuroiwaKentaro Kuroiwa Fukuoka, Japan More articles by this author , Akira YokomizoAkira Yokomizo Fukuoka, Japan More articles by this author , and Seiji NaitoSeiji Naito Fukuoka, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1419AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopic adrenalectomy (LA) is a safe and feasible approach to adrenal pathology, providing the patients with the benefits of minimally invasive surgery. In contrast to other adrenal tumors, pheochromocytoma was once considered as a contraindication for LA. Recently improved peri-operative management and advances in laparoscopic surgery have resulted in LAs becoming the standard of care for small pheochromocytomas. However, there are still some debates for the safety and feasibility of LA for large pheochromocytoma because of the difficult techniques and the possibility of uncontrollable hypertensive crises, hemorrhage, and malignancy. The aim of this study was to evaluate the validity of LA for pheochromocytoma and to investigate the risk factors that affect the intra-operative hypertension. METHODS Clinical data were retrospectively reviewed. From April 1997 to March 2012, 253 LAs were performed in our hospital. 56 cases were diagnosed as pheochromocytoma. The operative data and characteristics such as gender, age, laterality, tumor size, operating time, blood loss and preoperative catecholamine level in plasma and urine were compared to the intra-operative systolic blood pressure (SBP) variations. RESULTS In a comparison of operative data during LAs for pheochromocytoma or other adrenal tumors, we detected significant differences in operative time and blood loss. However, operative time and blood loss were improved significantly in recent cases compared with initial cases of LAs for pheochromocytoma. Therefore, no significant difference was detected in comparison of these operative data during LAs performed only recently. Although the intra-operative SBP rose to 180 mmHg or more in 30 cases (53.6%) and 200 mmHg or more in 16 cases (28.6%) in LAs for pheochromocytoma, no patient experienced a hypertensive crisis with uncontrollable high blood pressure. In a comparison of SBP (<200 vs. >200 mmHg) showed that the tumor size was significant risk factor for intra-operative hypertension (P=0.045). Furthermore patients with high preoperative plasma epinephrine level greater than 3 fold of upper normal limit were associated with higher incidence of intra-operative hypertension (P=0.003). CONCLUSIONS Laparoscopic adrenalectomy is not contraindicated for pheochromocytoma and can be performed safely. The tumor size and high pre-operative plasma epinephrine level might be risk factors for the intra-operative high SBP. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e17 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Junichi Inokuchi Fukuoka, Japan More articles by this author Katsunori Tatsugami Fukuoka, Japan More articles by this author Kentaro Kuroiwa Fukuoka, Japan More articles by this author Akira Yokomizo Fukuoka, Japan More articles by this author Seiji Naito Fukuoka, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...