Laparoscopic Adrenalectomy: New Gold Standard

Smith, C. Daniel; Weber, Collin J.; Amerson, J R

doi:10.1007/pl00012314

Cited by 357 publications

(243 citation statements)

References 30 publications

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“…In 1996 Gagner et al published a series of laparoscopic cases showing that minimally invasive access is safe and feasible (4). Over the last two decades adrenal gland surgery has transformed, so that laparoscopic access has become the gold standard in the surgical treatment of adrenal tumors, including pheochromocytomas (5,6). The advances in operative technique and perioperative management have lowered mortality rates to 0-3% with complications occurring in 5% to 22% of patients (4,(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

Pisarska¹,

Pędziwiatr²,

Budzyński³

2016

Gland Surg.

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Section: Introductionmentioning

confidence: 99%

Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

Pisarska¹,

Pędziwiatr²,

Budzyński³

2016

Gland Surg.

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“…There are two main approaches for laparoscopic adrenal surgery: transperitoneal and retroperitoneoscopic (posterior or lateral). In laparoscopic adrenalectomy, the transperitoneal approach was used for the first time and it is still the most popular technique because of the large space for working, greater visibility, and good instrument mobility [7]. In our case, the contralateral metastatic adrenal mass was measured as 6.5 x 4.5 cm in preoperative imaging and it was removed successfully by LTA.…”

Section: Discussionmentioning

confidence: 74%

Synchronous Bilateral Adrenal Metastases from Papillary Renal Cell Carcinoma

Gökçen¹

2016

Ann Clin Anal Med

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ÖzetRenal hücreli karsinomun eş zamanlı bilateral adrenal metastazını saptadığımız olguyu sunuyoruz. Olguda renal kitle ve aynı taraftaki adrenal bez metastazı açık cerrahiyle en blok çıkartılırken kontrlateral adrenal metastazı için eş zamanlı olarak laparoskopik transperitoneal yaklaşım terci edilmiştir. Kliniğimize başvuran 54 yaşındaki erkek olguda preoperatif bilgisayarlı tomografide primer tümör böb-reğin üst ve orta polüne lokalize olduğu izlendi. Kontrlateral metastatik adrenal tümör 65x 45 mm ve ipsilateral adrenal metastaz 140x 65 mm idi. Tetkikler sonrasında başka bir metastaz saptanmaması üzerine laparoskopik kontrlateral adrenalektomi ve ipsilateral açık nefroadrenalektomi eş zamanlı olarak uygulandı.Primer renal kitlelere bağlı eş zamanlı adrenal tutulum oldukça nadir görünmek-te olup uygun cerrahi yaklaşım metastaz boyutlarına ve hastanın performans durumuna göre belirlenmelidir. Anahtar KelimelerLaparoskopi; Adrenalektomi; Metastaz ; Renal Hücreli Kanser AbstractWe report a case of synchronous bilateral adrenal metastasis of renal cell carcinoma. The contralateral metastatic adrenal mass was treated by the laparoscopic transperitoneal approach. The renal mass and its huge ipsilateral metastatic adrenal gland were removed en bloc with open procedure. A 54-year-old man presented to our clinic with left-sid renal cell carcinoma synchronously bilateral adrenal metastases. The primary tumor was localized in the upper-mid pole of the kidney. The diagnosis was established preoperatively by computed tomography. The size of the contralateral adrenal mass was 65 x 45 mm, but the ipsilateral metastatic adrenal mass was huge (140 x 65 mm). After all analysis and other scannings for any metastasis, a contralateral lapararoscopic transperitoneal adrenalectomy and a left open nephroadrenalectomy were performed simultaneously. Synchronous bilateral adrenal metastases from primary renal cell carcinoma without another metastasis is very rare. The optimal surgical procedure should be selected according to the metastatic adrenal masses size and the patient's status. Keywords IntroductionRenal cell carcinoma (RCC) is the most common malignancy within the kidney at the rate of approximately 90% of all renal tumors. RCC has different subtypes with specific histopathological characteristics. This malignancy is more common in males than females (1.5:1) and the highest incidence is observed between the 6th and 7th decades [1]. Nearly 25% of RCC patients already have multiple distant metastases at the time of presentation. RCC can metastasize to every organ, but especially to the lungs, bones, and brain. The incidence of synchronous metastasis into the ipsilateral adrenal gland has been reported to be 2-10% [2]. Whereas metastasis of RCC to different sites is not uncommon, adrenal metastasis is synchronous in 2.7%, metachronous in 1.0%, ipsilateral in 1.9%, contralateral in 1.5%, and bilateral in 0.3% of patients [3].We reported a case of laparoscopic transperitoneal contralateral metastatic adrenalectomy and concomitant ...

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“…[8][9][10][11] The choice of surgical approach depends mainly on the surgeons' experience and orientation, as well as the tumor pathology, size, function, and the patient's clinical history. Initially, we started laparoscopic adrenalectomy for nonfunctioning small tumors, and later on, laparoscopic adrenalectomy became our procedure of choice for all adrenal tumors, unless there was proven or highly suspicious malignancy.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic vs. Open Adrenalectomy: Experience at King Faisal Specialist Hospital and Research Centre, Riyadh

et al. 2003

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Background:The laparoscopic approach for adrenalectomy is now widely accepted and preferred over the conventional open approach. We describe our experience of adrenalectomy and compare the results of open and laparoscopic approach. Patients and Methods: From March 1999 to March 2002, we performed 23 adrenalectomies. An anterior transabdominal approach was used for the open procedure, and a lateral transperitoneal approach for the laparoscopic procedure. Data from both groups were analyzed and compared. Results: There was no difference in tumor size or pathology between the two groups. The tumor size was smaller, operative time was longer and estimated blood loss was less in the laparoscopic procedure group, however these differences were statistically insignificant. The mean length of hospital stay was shorter (5.1 vs. 9.2 days, P< 0.01), the mean use of postoperative narcotic analgesia was less (4.2 vs. 8.1 injections, P< 0.05), and the mean time for resumption of oral intake was faster (1.17 vs. 2 days, P< 0.01) in the laparoscopic procedure group compared to the open adrenalectomy group. Conclusion: Laparoscopic adrenalectomy is a safe procedure that can be performed for most adrenal pathology. It is associated with faster recovery, less postoperative pain, and shorter hospital stay.

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Laparoscopic Adrenalectomy: New Gold Standard

Cited by 357 publications

References 30 publications

Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

Synchronous Bilateral Adrenal Metastases from Papillary Renal Cell Carcinoma

Laparoscopic vs. Open Adrenalectomy: Experience at King Faisal Specialist Hospital and Research Centre, Riyadh

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