Laparoscopic Adrenalectomy In Children Research Articles

Are There Any Limiting Factors of Minimally Invasive Adrenalectomy in Children? Over 20-Year Single-Center Experience.

<b> Introduction:</b> Laparoscopic adrenalectomy is more widely recognized as a valuable treatment method for benign and malignant tumours. </br></br> <b>Aim:</b> This study reviews over 20-year experience with laparoscopic adrenalectomy in children in Central-West Poland. </br></br> <b>Materials and methods:</b> During the last 21 years, 5041 laparoscopic procedures were performed, among them 39 adrenalectomies in children aged from 2 days to 17 years. The following data were analysed: patient's age at diagnosis and surgery, lesion volume in CT/MRI examination, duration of surgery, the incidence of complication after surgery, and length of hospitalization. </br></br> <b>Results:</b> The volume of adrenal lesion visualized by CT or MRI before surgery varied from 0.5 cm3 up to 490 cm3, with a median of 14 cm3. As many as 80% of adrenalectomies allowed radical removal of the lesion and 92% of those procedures were performed without any complications. From all data analysed, only age, both at diagnosis and at surgery, was significantly lower in patients with a malignant lesion. </br></br> <b>Conclusions:</b> Laparoscopic adrenalectomy is a valuable method to use in paediatric patients for both benign and malignant adrenal lesions. However, in patients with malignant adrenal lesions it may be expected that the procedure will be more difficult due to the lower age and larger lesion size.

Laparoscopic Right Adrenalectomy After Superior Heminephrectomy in a Child

Introduction: Laparoscopic adrenalectomy (LA) is widely described in adult population since its first report by Gagner et al. in 1992.1 In contrast, its applicability in pediatric malignancy remains unsettled. According to current evidence, LA in children is acceptable for resection of pheochromocytomas,2 benign tumors, and adrenal hyperplasia.3 The authors present a video of a challenging laparoscopic right adrenalectomy in a child after homolateral superior polar heminephrectomy. Materials and Methods: This is a case of an 11-year-old girl with LiFraumeni syndrome. She had a past medical history of a central nervous system glioma treated when she was 4 years old. Six years later, a nodule on the upper pole of the right kidney with malignant features on imaging was diagnosed, and she underwent right superior heminephrectomy through a subcostal retroperitoneal approach. The specimen revealed that it was an eosinophilic renal carcinoma. One year later, during follow-up, a new nodule on the right adrenal gland was found. Because of the patient's history and malignant risk, she was proposed to tumor excision using a minimally invasive approach. During laparoscopy, important adhesions between the abdominal wall, the kidney, and the right lobe of the liver were found. After careful liberation and dissection, the adrenal tumor was found and excised. The postoperative course was uneventful and was discharged on the second postoperative day. After 1 year, the girl is doing well and is still under surveillance for further tumor development. Conclusion: A laparoscopic approach transforms a major surgery that requires a significant abdominal incision to operate in a difficult access area into a relatively simple and safe procedure. Particularly in patients in whom further surgeries are expected during their lifetime, a minimally invasive approach grants less future iatrogenic complications because of diminished risk for adhesion formation. No competing financial interests exist. Runtime of video: 7 mins 29 secs

Laparoscopic adrenalectomy in children: A 25-case series and review of the literature

BackgroundLaparoscopic adrenalectomy (LA) is the gold standard and is widely performed in adults, but its use in children is relatively new. We aim to present our experience in twenty-five children with diverse adrenal pathologies and to discuss an extensive review of pediatric LA in English literature. MethodsMedical records of children with adrenal tumors admitted to a tertiary center and treated with LA were reviewed. Characteristics and outcome of patients were compared with results of a systematic Pubmed/Medline literature review. ResultsTransperitoneal LAs were performed for 12 malignant and 14 benign adrenal masses (size range: 2–8cm) in 25 children (median age:63months). Fourteen lesions were on the right side, and there was one bilateral case. There were no conversion and no complication within 36months of follow-up. A literature review revealed 437 pediatric LAs with left side predomination (51.4%). The indication was a malignant lesion in 60.2% of the cases (sizes range: 1–10cm). The transperitoneal route was preferred in 94.2% of the procedures. Conversion and complication rates were 7.5% and 3.1%, respectively. ConclusionLA should be preferred in selected children with adrenal pathologies. The transperitoneal route seems to be the standard approach for pediatric surgeons. Preoperative planning and surgical expertise are the keys to success. Type of the studyCase series with systematic literature review. Level of evidenceIV.

Transperitoneal Laparoscopic Adrenalectomy in Children

Introduction: The use of a minimally invasive approach for adrenalectomy is poorly defined in pediatric patients, although laparoscopic adrenalectomy is considered a standard procedure in adults.1–4 The aim of our video is to describe the safety and feasibility of transperitoneal lateral laparoscopic adrenalectomy in children based on surgical skills and results. Surgical Procedure: The patient was placed in a reverse Trendelenburg semilateral position over a flank lift. A 10 mm Hg pneumoperitoneum was created using a 10- to 12-mm Hasson's trocar and three 5-mm trocars were inserted, as shown in the video. Left Adrenalectomy: A plane along the anterior surface of the kidney, lateral and dorsal to the spleen and tail of pancreas, was established and the splenic ligaments were divided. The dissection proceeded along the anterior surface of the kidney and adrenal gland until the inferior and medial border. The main adrenal vein and artery were isolated and sectioned. The dissection proceeded in a superolateral direction until complete mobilization of the gland. Right Adrenalectomy: The liver was retracted and the right lobe was mobilized, thus revealing the anterior surface of the adrenal gland. The lateral border of the inferior vena cava was isolated to identify the adrenal vein transacted. The dissection proceeded in a mediolateral and superoinferior direction, until complete mobilization of the gland. Materials and Methods: This is a retrospective study of four pediatric laparoscopic adrenalectomies (two right and two left) performed at our center. Preoperative workup included endocrinologic and radiologic investigation to determine the secretory activity, size, and local extent of the lesion. Results: The mean age was 87 months. Indications for surgery were two neuroblastomas, one aldosterone-secreting adrenocortical tumor, and one adrenocortical nodular hyperplasia. The mean size of the lesions was 3.23 cm at the pathologic examination. No intraoperative complications or conversions occurred. The average operating time was 85 minutes for right and 125 minutes for left adrenalectomies. The mean hospital stay was 3.75 days. At 15 months, the follow-up was negative. Conclusions: Transperitoneal laparoscopic adrenalectomy is a safe, feasible, and reproducible approach for the treatment of benign and malignant adrenal masses in children. Furthermore, this approach offers many advantages, including shortening of operating times and postoperative hospital stays, as well as reduction of blood loss and complications; also, a large working space with a clear view of the structure that permitted to perform a controlled resection.5,6 The authors have nothing to disclose. Runtime of video: 8 mins

Clipless laparoscopic adrenalectomy in children and young patients: a single center experience with 12 cases.

Laparoscopy is the gold standard approach for management of some adrenal masses in adult cases. Still there have not been many findings in case of children. We present our experience with clipless laparoscopic adrenalectomy in pediatric cases for the first time. From January 2007 to January 2011, thirteen laparoscopic adrenalectomy were performed in patients 5-18 years old. The first port (10 mm) was inserted using open approach above the umbilicus and three 5 mm trocars were inserted under direct vision. On the left side, the colon was mobilized medially, then the renal vein exposed. Adrenal vein was coagulated using bipolar cautery after separating from renal vein. No endoscopic clips were used. Eight girls and five boys with the mean age of 14.4 years old (ranging from 5 to 18 years old) underwent laparoscopic adrenalectomy. The mean operative time was 151 ± 47 (80- 240) minutes. The mean size of adrenal lesions in greatest diameter was 6.9 ± 2.4 cm (3.5 to 10). The mean hospital stay was 3.7 days (2-5) and average follow-up time was 21 months (6-27). Laparoscopic adrenalectomy in children and young adults is effective and safe if the cases are selected appropriately. Clipless laparoscopic approach by an expert surgeon has acceptable outcomes.

Laparoscopic Adrenalectomy in Children for Neuroblastoma

Neuroblastoma is one of the most common solid tumors in the pediatric population and the adrenal gland is the main abdominal site of this tumor. The laparoscopic approach has become the standard of care for most benign adrenal tumors in adults, but the role of laparoscopic adrenalectomy in children for malignant tumor is still a point of controversy. However, there is a growing experience with laparoscopic neuroblastoma resection of small lesions and the use of minimally invasive techniques for the initial management of infiltrative neuroblastoma in the last years. The aim of this study is to describe our initial experience with laparoscopic adrenalectomy for neuroblastoma in children, based on surgical outcomes. A retrospective review of 7 laparoscopic adrenalectomies performed in a single institution between October 2008 and October 2009. We focused our analysis on early surgical outcomes. The mean tumoral size was 2.8±0.9 cm, the average surgical time was 138.6±65.5 minutes, and the mean hospital stay was 2.9±1.6 days. One stage IV patient was submitted to conversion due to bleeding and needed blood transfusion. There were no late complications or deaths and the mean follow-up time was 18.8±6.1 months. The laparoscopic approach for adrenal neuroblastoma resection is feasible in children with good outcomes, but should be reserved to patients with small, well-circumscribed adrenal lesions, without invasive or infiltrative disease.

Laparoscopic adrenal surgery in children: Lessons from a single centre experience

PURPOSE:Although commonly performed in adults, laparoscopic adrenalectomy in children is performed only in centres with advanced laparoscopic expertise.MATERIALS AND METHODS:This is a retrospective analysis of laparoscopic adrenalectomies performed at a single centre between January 2003 and May 2010. After preoperative evaluation with biochemical assays and radiologic imaging, surgery was performed by using the lateral transabdominal approach in all patients.RESULTS:Ten laparoscopic adrenalectomies (including three bilateral) were performed in seven children, with a mean age of 9.6 years. The tumours ranged from 2 – 7 cms in size. The operative durations were 75 – 130 minutes (unilateral) and 250 – 270 minutes (bilateral). Operative blood loss was minimal. There were no open conversions, but terminal hand assistance was required in one large right pheochromocytoma. The postoperative hospital stay ranged from 3 – 10 days. The final pathological diagnoses included pheochromocytoma, hyperplasia and neuroblastoma. Follow-up at 24 – 87 months was uneventful.CONCLUSION:With adequate experience in laparoscopy, it is possible to perform adrenalectomy in selected children.

POD-1.05: Laparoscopic Adrenalectomy in Children: A Safe and Effective Procedure

POD-1.05: Laparoscopic Adrenalectomy in Children: A Safe and Effective Procedure

Feasibility and Safety of Laparoscopic Adrenalectomy in Children: Special Emphasis on Neoplastic Lesions

Laparoscopic adrenalectomy (LA) in children became a viable option for the resection of adrenal lesions. Few reports have been published in the last few years documenting its safety and feasibility. In this paper, we report our experience with LA over the last 10 years, with special emphasis on malignant lesions. A retrospective chart review was undertaken for patients managed with LA from 1997 to 2006 at King Faisal Specialist Hospital and Research Center. Demographic and clinical data were retrieved and descriptive data were generated. Twenty-nine patients were managed with LA at our institution over that period. There were 16 females and 13 males with a median age of 3 years. Adrenal lesions were left sided in 15, right sided in 11, and bilateral in 3 patients. Twenty-one patients had malignant lesions, while 8 had benign lesions. Lesions ranged in size from 2.8 to 7 cm in diameter. There were 3 conversions (10%) to the open technique. Resection margins were positive for tumor in 5 cases (17%), and all had stage IV neuroblastoma. Follow-up range was from 9 months to 9.5 years (9 months to 6.3 years for malignant lesions). There were no major postoperative complications and no port-site metastasis. Three patients had local recurrence, 2 of them had free resection margins. One patient managed for bilateral neuroblastoma has stable residual disease 17 months after resection. Hospital stay ranged from 2 to 4 days. At the time of this report, 3 patients with neuroblastoma had died with progressive metastatic refractory disease. Our data have shown the feasibility, safety, and effectiveness of LA for adrenal lesions, including malignant tumors. The relatively long follow-up data regarding the malignant lesions attest to its role in the management of such lesions. Appropriate selection criteria and appropriate laparoscopic surgical expertise are required to ensure its success.

QS346. Outcomes Following Laparoscopic Adrenalectomy in Children

Introduction: The goal of this study was to delineate the outcome of pediatric patients undergoing laparoscopic adrenalectomy in comparison to standard open adrenalectomy. Methods: A retrospective review was performed of all patients undergoing adrenalectomy during a ten-year period at a tertiary care, children’s hospital. Charts were reviewed for patient demographics, operative length and technique, tumor size, and length of stay. Patients were grouped by either open or laparoscopic techniques.

The Safety and Efficacy of Laparoscopic Adrenalectomy in Children—Invited Critique

Hypothesis: Laparoscopic adrenalectomy (LA) has become standard therapy for benign adrenal masses in adults. The utility of LA in children with adrenal masses is less well defined because of the infrequency and pathologic variability of pediatric adrenal masses, and body size and instrumentation considerations that exist in small children. Evaluation of a case series of children undergoing lateral, transperitoneal LA will reflect the safety and efficacy of this procedure in pediatric patients and identify preferred patient selection criteria. Design: A combined case series including patients treated between March 1999 and November 2004. Setting: Urban tertiary referral pediatric teaching hospitals. Patients and Interventions: All children with pathologic adrenal masses undergoing LA were included. Main Outcome Measures: The primary study outcome measures included operative duration, conversions to open adrenalectomy, complications, length of hospital stay, and freedom from recurrence of the original pathologic adrenal mass. Results: A total of 21 LAs (including a staged, bilateral LA) were performed in 20 patients (13 girls, 7 boys) with a mean age of 6.4 years (range, 14 months to 18 years). Nine patients (43%) had neuroblastic tumors. Operative duration averaged mean±SD 101±48 minutes, and there was a single conversion to open adrenalectomy in a patient with a left adrenal carcinoma and tumor thrombus extending into the renal vein. There were no peri-operative complications, and no patients required blood transfusions. The postoperative hospital stay averaged 1.5 days (range, 1-4.5 days). At a mean±SD follow-up of 31±17 months, all patients remained clinically (radiologically and/or biochemically) free of their original adrenal disease. Conclusion: Laparoscopic adrenalectomy can be used to safely treat suspected benign and selected malignant adrenal masses in children.

The Safety and Efficacy of Laparoscopic Adrenalectomy in Children

Laparoscopic adrenalectomy (LA) has become standard therapy for benign adrenal masses in adults. The utility of LA in children with adrenal masses is less well defined because of the infrequency and pathologic variability of pediatric adrenal masses, and body size and instrumentation considerations that exist in small children. Evaluation of a case series of children undergoing lateral, transperitoneal LA will reflect the safety and efficacy of this procedure in pediatric patients and identify preferred patient selection criteria. A combined case series including patients treated between March 1999 and November 2004. Urban tertiary referral pediatric teaching hospitals. All children with pathologic adrenal masses undergoing LA were included. The primary study outcome measures included operative duration, conversions to open adrenalectomy, complications, length of hospital stay, and freedom from recurrence of the original pathologic adrenal mass. A total of 21 LAs (including a staged, bilateral LA) were performed in 20 patients (13 girls, 7 boys) with a mean age of 6.4 years (range, 14 months to 18 years). Nine patients (43%) had neuroblastic tumors. Operative duration averaged mean +/- SD 101 +/- 48 minutes, and there was a single conversion to open adrenalectomy in a patient with a left adrenal carcinoma and tumor thrombus extending into the renal vein. There were no perioperative complications, and no patients required blood transfusions. The postoperative hospital stay averaged 1.5 days (range, 1-4.5 days). At a mean +/- SD follow-up of 31 +/- 17 months, all patients remained clinically (radiologically and/or biochemically) free of their original adrenal disease. Laparoscopic adrenalectomy can be used to safely treat suspected benign and selected malignant adrenal masses in children.

Experience with laparoscopic adrenalectomy in children

Purpose The aim of this study was to review the authors’ experience with laparoscopic adrenalectomy in the pediatric age group. Methods This is a retrospective analysis of laparoscopic adrenalectomies performed in children at King Faisal Specialist Hospital & Research Centre, between June 1997 and March 2003. Ten children had laparoscopic adrenalectomies during this period. They were between 3 weeks to 12 years of age and there was an equal number of boys and girls. Case selection was based mainly on the size of the lesion and its localized nature as seen on the imaging studies. The transperitoneal approach was used in all cases. Results Eleven laparoscopic adrenalectomies were performed in 10 children (1 was bilateral adrenalectomy). Presenting features were virilization (n = 3), Cushing’s syndrome (n = 1), antenatally detected adrenal cyst (n = 1), hypertension (n = 1), hepatomegaly (n = 1), loin pain with hematuria (n = 1) and an incidental adrenal mass (n = 1). One was a child with stage IV adrenal neuroblastoma postchemotherapy for resection of the residual tumor. On imaging studies, the tumors were between 2.8 and 7 cm in their largest dimension. Operating time ranged from 118 to 180 minutes in the unilateral resections, whereas the bilateral laparoscopic adrenalectomy required 330 minutes. Two had to be converted to open procedures. Postoperative hospital stay was between 2 and 15 days. Pathologic diagnoses were as follows: adrenal cortical adenoma (n = 3), adrenal medullary hyperplasia (n = 2), adrenal cortical carcinoma (n = 1), ganglioneuroma (n = 1), and neuroblastoma (n = 3). There were no complications. Follow-up ranged from 3 months to 6 years. The only mortality in our study group was in the child with stage IV neuroblastoma who died of disseminated disease 9 months later. In the rest, there has been no local recurrence or metastases, and the biochemical and hormonal parameters have remained normal in the functional tumors. Conclusions We believe that in a select group of pediatric adrenal lesions, laparoscopic adrenalectomy is a safe and effective procedure with the potential benefits of minimally invasive procedures.

Experience with laparoscopic adrenalectomy in pediatric patients

Background: Laparoscopic adrenalectomy (LA) is now being recognized as the standard in the management of benign adrenal pathology in adult patients. Few reports have described the use of this technique in pediatric patients. This study combines experience from 2 institutions with lateral transperitoneal LA in children to analyze our results and the clinical and biochemical response to laparoscopic adrenalectomy in patients with hormonally active adrenal tumors. Methods: A bi-institutional retrospective review of all patients undergoing LA between January 1997 and January 2001 was performed. Clinical and biochemical data were obtained during routine follow-up. Results: Seventeen laparoscopic adrenalectomies were performed during this period. The average operating time was 120 minutes, mean estimated blood loss was 25 mL, the mean size of the adrenal lesion was 4.8 cm, and the mean length of hospitalization was 35 hours. Resolution of clinical and biochemical parameters of adrenal hyperfunction was accomplished in all patients with adrenocortical hyperplasia and pheochromocytoma in postoperative follow-up. Conclusions: Laparoscopic adrenalectomy can be performed safely and effectively with a short hospital stay, minimal blood loss, and excellent functional outcome in this age group. The authors believe laparoscopic adrenalectomy is an excellent approach for the management of benign pediatric adrenal pathology. J Pediatr Surg 37:979-982. Copyright 2002, Elsevier Science (USA). All rights reserved.

Laparoscopic adrenalectomy in children

The aim of this study was to describe the indications and results of laparoscopic adrenalectomy in children. This retrospective multicenter study included six children (four boys, two girls) aged 2-16 years (mean, 9.5). Three children had hypertension. In three cases, the adrenal mass was discovered incidentally. The tumors were bilateral in two children, right-sided in two cases, and left-sided in two cases. The mean tumor size was 4 cm (range, 1-7). Each child underwent MIBG scintigraphy and MRI before the operation. Four right and two left adrenal glands were resected by laparoscopy (transperitoneal), and two left glands were resected by retroperitoneoscopy. Two conversions were necessary for two left adrenal glands (one retroperitoneoscopy, one laparoscopy). Two partial resections and six adrenalectomies were performed. Histological examination of the tumors revealed two ganglioneuromas, one neuroblastoma, and five pheochromocytomas (two bilateral). One child had an involved node (pheochromocytoma). Both bilateral pheochromocytomas had von Hippel-Lindau disease. There was no morbidity. Mean hospitalstay was 6 days. Postoperative evaluation at 1 month was normal in all children. The indications for laparoscopic adrenalectomy in children are benign tumors and pheochromocytomas. In these cases, laparoscopic adrenalectomy is feasible and safe, even in cases of pheochromocytoma.