Laparoscopic Surgery for Pheochromocytoma

Rocha, Marcos Flávio Holanda; Faramarzi-Roques, Rozbeh; Tauzin-Fin, P.; Vallée, Vincent; Vasconcelos, Paulo Roberto Leitão de; Ballanger, P.

doi:10.1016/j.eururo.2003.09.016

Cited by 72 publications

(15 citation statements)

References 27 publications

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“…Several studies have shown that tumor manipulation is the most significant intra-operative stimulus for catecholamine release during both open and laparoscopic approaches (13, 27–29). This is where operative experience with larger pheochromocytomas can make a difference in outcome.…”

Section: Discussionmentioning

confidence: 99%

“…This is where operative experience with larger pheochromocytomas can make a difference in outcome. Rocha et al reported that even with early adrenal vein ligation, it is most likely the vascularity that results in the large amount of hormone release (13). Even though we did not measure intra-operative catecholamine levels, our strategy of minimal direct manipulation of both the tumor and the adrenal gland and early venous control suggests that this surgical technique employed by experienced surgeons results in low incidence of catecholamine-induced cardiovascular instability.…”

Section: Discussionmentioning

confidence: 99%

“…The progress made in minimally invasive surgery has allowed it to be expanded to larger tumors, metastatic malignancies, and the presentation of bilateral pathology (7–12). Lastly, the intra-abdominal insufflation and the hypercapnia and acidosis resulting from the CO 2 pneumoperitoneum required for laparoscopic surgery, may increase serum catecholamine levels and hypertension, but not necessarily result in a higher incidence of adverse peri-operative cardiovascular events, over time (13, 14). …”

Section: Introductionmentioning

confidence: 99%

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Safety and Feasibility of Laparoscopic Resection for Large (≥ 6 CM) Pheochromocytomas Without Suspected Malignancy

et al. 2012

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Objective The safety and efficacy of laparoscopic adrenalectomy has been well documented and it has become the standard of care for benign adrenal pathology, and small (<5cm) pheochromocytomas. Its applicability for pheochromocytomas larger than 6 cm has been questioned, due to concerns including cardiovascular complications, malignancy, and recurrence. The aim of this study is to determine if laparoscopic adrenalectomy in patients without radiologic evidence of cancer, compromises the peri-operative and long-term outcomes of large ≥6 cm pheochromocytomas. Methods We analyzed a prospective adrenal database of 163 consecutive patients who underwent adrenalectomy at our institution between September 2000 and September 2010, under an Institutional Review Board approved protocol. Patients diagnosed with a pheochromocytoma, who underwent laparoscopic adrenalectomy (LA) were investigated. Patients with tumors <6 cm (SmPheo) were compared to those presenting with tumors ≥6 cm (LgPheo). Results Twenty-five patients presented with 26 pheochromocytomas. There were 52% females with a mean age of 53±3. The mean tumor size was 5.2±0.5cm and 11 (42%) pheochromocytomas were ≥6 cm. The tumor size was significantly different between the LgPheo and the SmPheo groups (7.6±0.4 vs. 3.6±0.4 cm, p<0.001) but there was no significant difference in intra-operative complications, estimated blood loss, cancer diagnosis, or recurrence. The length of stay was comparative amongst the two cohorts and there were no incidents of capsular invasion or adverse cardiovascular events. Conclusion Laparoscopic adrenalectomy of pheochromocytomas larger than 6 cm is feasible and safe with comparable results to smaller ones.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Safety and Feasibility of Laparoscopic Resection for Large (≥ 6 CM) Pheochromocytomas Without Suspected Malignancy

et al. 2012

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“…What is more, there is better haemostasis of the operative area due to vessel compression. Opponents of the method have suggested that increased CO 2 pressure creates a risk of gas embolism and ejection of catecholamines [31]. Those findings have not been confirmed in practice [14, 22].…”

Section: Methodsmentioning

confidence: 99%

Videoscopic adrenalectomy - when does retroperitoneal seem better?

Myśliwiec¹,

Marek-Safiejko

Łukaszewicz³

et al. 2014

Videosurgery and Other Miniinvasive Techniques

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IntroductionVideoscopic adrenalectomy is the gold standard for the surgical treatment of benign adrenal tumours. The two most common approaches are the lateral transperitoneal approach (LTA) and the posterior retroperitoneal approach (PRA). So far it has not been established which is the preferable one. The choice depends primarily on the surgeon's preference and contraindications for a particular approach in individual cases.AimTo compare the two most common approaches for videoscopic adrenalectomy, LTA and PRA, based on a literature review and our own experience.Material and methodsWe reviewed the literature (PubMed and Cochrane 1990 – current) and analysed retrospectively our own patients who underwent videoscopic adrenalectomy between 2009 and 2013. The analysis covered patient features, tumour characteristics, reasons for qualification for each approach, operative time and postoperative complications.ResultsOut of 71 videoscopic adrenalectomies, 50 were performed using PRA and 21 using LTA. Patients in the PRA group on average were older, but had smaller tumours. There was no significant difference in perioperative morbidity between PRA and LTA. Mean blood loss and total operative time were smaller/shorter for the PRA group in comparison to the LTA group. Time to first oral intake and the average postoperative hospital stay were shorter for PRA than LTA.ConclusionsVideoscopic adrenalectomy is a safe and efficient technique performed using both LTA and PRA approaches. The choice of technique should be guided, most of all, by surgeon experience, patient characteristics, tumour size and location. Our preferable approach is PRA, especially for small (< 6 cm) benign tumours. We find LTA advantageous for tumours of larger size, with suspected malignant character (either primary or secondary), in ectopic position, as well as in patients lacking an ipsilateral kidney or when a simultaneous abdominal operation is planned.

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“…All of these preoperative preparations followed classical principles reported in previous publications or the latest guidelines. 6 Patients with urinary tract infections received antibiotic therapy according to the results of the urine bacterial culture.…”

Section: Methodsmentioning

confidence: 99%

Modified Retroperitoneoscopic Port Sites for Surgery of Upper Urinary Tract

Wang

2014

JSLS

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Background and Objectives:Our objective was to introduce our experience using modified retroperitoneoscopic port positions for operations of the upper urinary tract.Methods:We designed different trocar positions or incisions according to different surgical procedures and specimen sizes. A total of 116 patients, comprising patients with common adrenal, kidney, and ureter diseases, underwent retroperitoneoscopic operations by use of modified incisions. These patients comprised 23 with adrenal diseases, 84 with kidney diseases, and 9 with ureter diseases. The specimen was retrieved, as much as possible, through a transverse incision to produce a hidden scar after recovery. By contrast, 143 patients underwent the same or similar procedures using classical 3-port incisions. The operative time was defined as the time from skin incision to skin closure.Results:There were no significant differences in age, estimated blood loss, oral intake, and hospital stay between groups. A significant difference in favor of the modified group was noted with respect to analgesia use (diclofenac sodium, 50 mg vs 100 mg; P < .05) in all 3 modified methods, as well as in cosmetic outcome in the groups undergoing the first modification (score, 8.9 ± 2.2 VS 7.3 ± 2.8; P < .05) and second modification (score, 8.7 ± 2.5 VS 7.1 ± 2.4; P < .05). In addition, the mean operative time in patients undergoing ureter operations was shorter than that in the conventional group using classical 3-port positions (55 ± 11 minutes vs 70 ± 15 minutes, P < .05).Conclusions:Our modified retroperitoneoscopic incision is a safe, cosmetic alternative procedure for operations of the upper urinary tract. Different diseases and specimen sizes can be treated with the personalized or suitable incisions that we have introduced.

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Laparoscopic Surgery for Pheochromocytoma

Cited by 72 publications

References 27 publications

Safety and Feasibility of Laparoscopic Resection for Large (≥ 6 CM) Pheochromocytomas Without Suspected Malignancy

Safety and Feasibility of Laparoscopic Resection for Large (≥ 6 CM) Pheochromocytomas Without Suspected Malignancy

Videoscopic adrenalectomy - when does retroperitoneal seem better?

Modified Retroperitoneoscopic Port Sites for Surgery of Upper Urinary Tract

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