Posterior Retroperitoneoscopic Adrenalectomy - Clnical Evaluation of the Method Based on the Four-Year Experience

Abstract

The aim of the study was to present the authors' four-year experience in employing posterior retroperitoneoscopic adrenalectomy according to Walz (PRA) in surgical treatment of adrenal tumors up to 6 cm in size. Results. The mean operative time was 73.7±22.3 min. A single conversion (1.2%) was required, as well as a single early reoperation (1.2%) due to bleeding. Following the initial 20 operations with the mean operative time of 86.5±34.6 min, the mean operative time of the remaining 63 procedures was 69.7±14.9 min (p=0.046) and did not exceed 90 min in any case. No correlation was noted between the operative time and BMI, tumor location and size. The procedures performed in patients with pheochromocytomas were not significantly longer in comparison to operations in hormonally inactive adrenocortical adenomas. Normalization of arterial blood pressure was achieved in all the patients with pheochromocytomas, aldosteronomas and subclinical glucocorticoidism aged below 50 years and with less than one-year history of secondary hypertension. Conclusions. Despite its seeming complexity resulting from operating in an "upside down" surgical field, the PRA surgical technique is easy to master and safe, also during the learning period. After the surgeon has performed approximately 20 operations, the operative time does not exceed 90 min. PRA is worthy of recommending in the case of adrenal tumors qualified for surgical treatment and not exceeding 6 cm in size.

Minimally invasive parathyroidectomy in patients with previous neck surgery

“…14,15 It should however be emphasized that the role of quick iPTH assay is still controversial for cost reasons, especially when two concordant results of preoperative imaging tests are available, although it is noteworthy that up to 5% of patients can still benefit. 16,17 The term PNS or reoperative neck can be divided into two groups. The first group concerns cases with non-parathyroid previous operation (thyroidectomy or other neck procedures) and the second concerns patients with previous parathyroidectomy; thus this means that the second group relates to persistent or recurrent PHP.…”