Laparoscopic adrenalectomy using the lateral retroperitoneal approach: Is it a safe and feasible treatment option for pheochromocytomas larger than 6 cm?

Chung, Ho Seok; Kim, Myoung Soo; Yu, Ho Song; Hwang, Eu Chang; Kim, Sun-Ouck; Oh, Kyung Jin; Jung, Seung Il; Kang, Taek Won; Park, Kwangsung; Kwon, Dong Deuk

doi:10.1111/iju.13524

Cited by 24 publications

(37 citation statements)

References 31 publications

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“…However, it was also mentioned that retroperitoneal approach requires a significant learning curve and that it’s a difficult procedure in obese patients 11. Chung et al reported the feasibility of laparoscopic adrenalectomy using retroperitoneal approach for large size PCC and outcomes were comparable 12. Both the techniques are similar and outcomes are comparable in the hands of experienced laparoscopic experts in field of urology.…”

Section: Discussionmentioning

confidence: 99%

Simple adrenal cyst masquerading clinically silent giant cystic pheochromocytoma

Kumar

Parmar²,

Aggarwal

et al. 2019

BMJ Case Rep

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Pheochromocytoma (PCC) may present as a cystic or solid tumour. Cystic PCCs are difficult to differentiate from simple cysts in the absence of classic symptoms of PCCs. Cystic nature develops due to intralesional bleeding and necrosis. We present a case of young man without any comorbidity who was diagnosed as a simple adrenal cyst and planned for laparoscopic excision but found to be functional PCC during the time of surgery only. The patient was managed with extensive monitoring and use of multiple drugs to control blood pressure. Surgery was completed without any complication laparoscopically and postoperative period was also uneventful. Histopathology confirmed the diagnosis of cystic PCC. Our case also shows the importance of functional imaging like metaiodobenzylguanidine (MIBG) scan in doubtful cases of adrenal cysts when other biochemical markers are unremarkable to diagnosis. We emphasise the importance of meticulous preparation for any intraoperative disasters even for apparently simple adrenal cyst.

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Section: Discussionmentioning

confidence: 99%

Simple adrenal cyst masquerading clinically silent giant cystic pheochromocytoma

Kumar

Parmar²,

Aggarwal

et al. 2019

BMJ Case Rep

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“…Regarding large pheochromocytoma, Chung et al . reported that RPA was a safe and feasible approach, but there was no comparison with TPA …”

Section: Discussionmentioning

confidence: 99%

“…18 Regarding large pheochromocytoma, Chung et al reported that RPA was a safe and feasible approach, but there was no comparison with TPA. 12 An investigation into which approach is preferable for large pheochromocytoma has been warranted.…”

Section: Discussionmentioning

confidence: 99%

“…Several reports have shown that laparoscopic removal of pheochromocytomas, including large tumors, can be completed safely with minimal operative morbidity through the TPA . Despite the accumulated evidence showing the superiority of the RPA for non‐pheochromocytoma, large adrenal tumors, the safety and efficacy of the RPA for large pheochromocytomas are very limited …”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11] Despite the accumulated evidence showing the superiority of the RPA for non-pheochromocytoma, large adrenal tumors, the safety and efficacy of the RPA for large pheochromocytomas are very limited. 12 The aim of the present study was to compare the outcomes of the TPA and RPA for laparoscopic removal of large pheochromocytomas (>5 cm in diameter).…”

Section: Introductionmentioning

confidence: 99%

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Transperitoneal versus retroperitoneal laparoscopic adrenalectomy for large pheochromocytoma: Comparative outcomes

et al. 2018

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Objectives To evaluate operative and oncological outcomes of laparoscopic adrenalectomy through a transperitoneal approach and retroperitoneal approach for large (>5 cm in diameter) pheochromocytomas. Methods We retrospectively compared the results of a transperitoneal approach with those of a retroperitoneal approach in 22 patients (mean age 57.5 years, range 38–76 years) with unilateral large pheochromocytomas (12 right, 10 left). The mean body mass index, operation time, pneumoperitoneum time, estimated blood loss, fluctuation in blood pressure and complication rate were compared between the two approaches. Results The mean tumor diameter (range) was 7.0 cm (range 5.2–15.5 cm), and no significant differences were observed between the transperitoneal approach and retroperitoneal approach in any baseline clinical parameter. For right‐sided procedures, significant differences were found for operation time (113 vs 85 min), pneumoperitoneum time (93 vs 64 min) and estimated blood loss (96 vs 23 mL; P < 0.05, transperitoneal approach and retroperitoneal approach, respectively). No open conversion or recurrence was reported, but one right transperitoneal approach case required blood transfusion. No difference in these parameters was noted on the left side. Conclusions For right side procedures, the retroperitoneal approach is feasible, safer and faster than the transperitoneal approach for large pheochromocytomas. Early transection of the feeding artery is beneficial for managing the tumor and reducing the risk of bleeding.

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