Retroperitoneoscopic Partial Adrenalectomy Research Articles

Tailored Approach in Adrenal Surgery: Retroperitoneoscopic Partial Adrenalectomy.

The interest on partial adrenalectomy has steadily increased over the past twenty years. Adrenal pathologies are mostly benign, making an organ-preserving procedure attractive for many patients. The introduction of minimally invasive techniques played probably an important role in this process because they transformed a complex surgical procedure, related to the difficult access to the retroperitoneal space, into a simple operation improving the accessibility to this organ. In this review we summarize the role of partial retroperitoneoscopic adrenalectomy over the years and the current indications and technique.

Single-Access Retroperitoneoscopic Partial Adrenalectomy in the Prone Position

Abstract Introduction: Reporting our experiences in performing single-access retroperitoneoscopic partial adrenalectomy in the prone position. Materials and Methods: Between Dec. 2010 and Dec. 2014...

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of cardiovascular complications, target organ damage and metabolic syndrome than essential hypertension. The laparoscopic removal of the adenoma has shown preferable and more beneficial than medical treatment or open surgery to manage functioning adrenal tumors. The authors ask an important and controversial question of organ-sparing adrenalectomy in patients with primary aldosteronism due to aldosteronoma. Moreover, they questioned the role of adrenal vein sampling as the gold standard diagnostic test to identify the side of aldosterone secretion versus high-resolution computerized axial tomography. The data revealed a total of 212 patients enrolled in this study, including 108 that underwent total adrenalectomy and 104 patients in the partial adrenalectomy group. No open conversion or blood transfusions were needed. No major intraoperative complications occurred and no tumor recurrence was noted during the mean 96-month follow-up. All patients in each group showed improvement in hypertension and in all plasma renin activity and plasma aldosterone recovered to normal after surgery. However, 32 of 108 patients (29.6%) with total adrenalectomy remained hypertensive with normal plasma aldosterone after surgery. Blood pressure was managed with 20 or 40 mg nifedipine retard daily. Patients with partial adrenalectomy no longer required antihypertensive medication after surgery and 29 patients (27.9%) were prescribed a decreased dose or fewer antihypertensive medications. The authors concluded that partial adrenalectomy for unilateral aldosterone producing adrenal adenoma is beneficial and may preserve adrenal function avoiding possible steroid replacement. Moreover, retroperitoneoscopic partial adrenalectomy is technically feasible with similar outcomes as total adrenalectomy in patients with primary aldosteronism due to aldosteronoma.

Retroperitoneoscopic partial adrenalectomy for small adrenal tumours (≤1 cm): the Ruijin clinical experience in 88 patients

Therapy (case series). 4. To present our experience of retroperitoneoscopic partial adrenalectomy (RPA) for small adrenal tumours, as with modern imaging methods small adrenal lesions are being diagnosed more commonly, and retroperitoneoscopic adrenal surgery for small adrenal tumours (< or =1 cm) can be challenging. We retrospectively reviewed the records of 389 consecutive retroperitoneoscopic adrenalectomies from September 2005 to December 2008, 88 of which were small adrenal tumours and treated by RPA. Ultrasonography and computed tomography (CT) were used in all patients before RPA, and magnetic resonance imaging or positron emission tomography/CT in some patients. We used RPA for adrenal tumours and total adrenalectomy for adrenal cancer. During the surgery, the internal part of the adrenal gland close to the retroperitoneum was freed first, and the whole adrenal tissue was dissected completely. The preoperative imaging was important in these procedures. There were no deaths; conversions to open surgery were necessary in four patients (4.5%), the reasons being a missing target in two, massive haemorrhage caused by central adrenal vein injury in one, and severe adhesion in one. The mean (range) size of the adrenal tumours was 0.7 (0.5-1.0) cm, including 69 aldosterone-producing adenomas, 11 nonfunctional adrenal adenomas, three Cushing syndrome, two phaeochromocytomas, two myelolipomas and one melanoma. The operative duration in the initial 38 cases was significantly longer than that in the subsequent 50 (P < 0.01). However, there was no significant correlation between estimated blood loss and the number of procedures. Tumour size did not correlate with estimated blood loss and operative duration. There was no significant correlation between body mass index and operative duration. RPA is a safe, effective and minimally invasive therapeutic option for patients with small adrenal tumours. With improved operative technique the RPA has been completed in more quickly. Freeing the internal part of the adrenal gland close to the retroperitoneum first, and exploring the whole adrenal tissue during surgery are the key points of RPA. The location of the small adrenal tumour can be different from that shown on imaging before surgery, and the abnormality of the adrenal gland should be considered.

VID-03.02: Retroperitoneoscopic Partial Adrenalectomy for Small Adrenal Tumors (≤1cm): The Rui-jin Clinical Experience in 96 Procedures

Retroperitoneoscopic adrenal surgery for small adrenal tumors ('1cm) can be challenging for its features and difficulties, and even probably be omitted intraoperatively. This is an attempt to present our experiences in the retroperitoneoscopic partial adrenalectomy for small adrenal tumors.

Case Report: Retroperitoneoscopic Partial Adrenalectomy for Large Adrenocortical Oncocytoma

A young woman had mild hypertension, and on evaluation, a large tumor arising from the right adrenal gland was found. The tumor was hormonally inactive. Retroperitoneoscopic partial adrenalectomy was carried out. The histopathology report described adrenocortical oncocytoma.

Posterior retroperitoneoscopic partial adrenalectomy: clinical experience in 47 procedures.

We evaluated posterior retroperitoneoscopic partial adrenalectomy with regard to operative complications, operation time, intraoperative blood loss. Between January 1997 and April 2002, we performed 47 posterior retroperitoneoscopic partial adrenalectomies. There were 18 males and 29 females with a mean age of 48 years (range 28-82 years). The average adrenal tumor size was 26 mm (range 10-50mm). All procedures required three trocars. There was no mortality and conversion rate to open surgery was 2.1%. Average operative time and average blood loss was 198.0 ml (range 71-420 ml) and 40.8 ml (range 0-1100 ml), respectively. There was a significant correlation of operative time with the number of procedures performed. However, no significant correlation was observed between intraoperative blood loss and the number of procedures. Tumor size did not correlate with intraoperative blood loss and operative time. No significant correlation was found between body mass index and operative time. The operative time in the initial 20 cases was significantly longer than that in the subsequent 26 cases. Posterior retroperitoneoscopic partial adrenalectomy is a safe and less invasive method for treatment of adrenal tumors. With improved operative technique, the time required for this procedure has been decreased.

Posterior retroperitoneoscopic partial adrenalectomy using ultrasonic scalpel for aldosterone-producing adenoma.

Posterior retroperitoneoscopic adrenalectomy has become a standard procedure, but removal of the entire gland is not necessary in all cases. We performed 10 posterior retroperitoneoscopic partial adrenalectomies for aldosterone-producing adenoma (APA) using an ultrasonic scalpel to divide the normal adrenal gland and the adenoma. The mean operation time and blood loss were 154 (110-231) minutes and 11 (5-32) mL, respectively. The mean weight of removed tissue was 5.7 g (2.3-10.2 g). Subcutaneous emphysema occurred in three patients, but there were no serious operative complications. Posterior retroperitoneoscopic partial adrenalectomy using the ultrasonic scalpel may be a valuable treatment for typical solitary APA.

Retroperitoneoscopic Partial Adrenalectomy Using an Endoscopic Stapling Device in Patients with Adrenal Tumor

We performed 15 retroperitoneoscopic partial adrenalectomies using an endoscopic stapling device to divide the normal adrenal tissue and adenoma. The mean operating time and mean blood loss were 162 (129–210) min and 12 (5–67) ml, respectively. In 1 patient (6.7%), a pneumothorax occurred at the end of the procedure due to injury of the medial crus of the diaphragm. However, the procedure was not subsequently converted to open surgery. These facts suggest that posterior retroperitoneoscopic partial adrenalectomy is a valuable addition to adrenal gland surgery.