Posterior retroperitoneoscopic partial adrenalectomy: clinical experience in 47 procedures

OBJECTIVES: We evaluated posterior retroperitoneoscopic partial adrenalectomy with regard to operative complications, operation time, intraoperative blood loss. PATIENTS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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 adrenalectomy for pediatric adrenal tumors

Background/aimsPosterior retroperitoneoscoic adrenalectomy has been reported as an option for adrenal tumor resection but is not commonly performed in children owing to the extreme semikneeling position advocated to flatten the lumbar lordosis in order to achieve adequate retroperitoneal space. As children have smaller lordosis angles, flattening of the lordosis and creation of optimal retroperitoneal space may be achieved with less hip flexion. We used pediatric lumbar lordosis measurements to develop a modified prone jackknife position and report our experiences with this setup for posterior retroperitoneoscopic adrenalectomy for adrenal tumors.MethodsLordosis angles were measured on sagittal computed tomography (CT) and magnetic resonance imaging (MRI) studies of patients with adrenal tumors and compared to normal references. The data were used to develop our modified prone jackknife position. Selected patients with adrenal tumors underwent posterior retroperitoneoscopic adrenalectomy in this position. Patient demographics, diagnoses, operative times, complications, postop analgesia requirements, and length of hospitalization were analyzed.ResultsCT and MRI studies were analyzed for 20 patients with adrenal tumors diagnosed in our institution from 2012 to 2017; median lordosis angle was 27.84° (range: 15.50°–36.48°) — less than reference lordosis angles of respective age groups, and flexion angles of common operating tables. Five patients underwent retroperitoneoscopic adrenalectomy between June 2016 and June 2018. Histological diagnoses were neuroblastoma, adrenal hyperplasia, pheochromocytoma, and adrenal angiomatoid fibrous histiocytoma. Median age was 4 years [range: 1–11]. Median operating time was 137 min [range 111–181 min]. No conversions to open surgery were required. One patient had intraoperative bleeding from the adrenal vein. Only 1 patient required postoperative opioids for analgesia. Median length of hospitalization after surgery was 2 days (range: 2–3 days).ConclusionsPediatric patients can achieve flattening of lumbar lordosis with less extreme positioning. Posterior retroperitoneoscopic adrenalectomy in a modified prone jackknife position is a feasible operation for pediatric patients with small adrenal masses.Type of studyClinical research paper.Level of evidenceLevel III.     

Partial laparoscopic adrenalectomy for aldosterone-producing adenoma: short-and long-term results

BACKGROUND AND PURPOSE: Laparoscopic surgery for adrenal gland tumors is the gold standard operative approach now. Adrenal-sparing surgery has special indications. We demonstrated the safety and feasibility of performing adrenal-sparing surgery by means of laparoscopy for aldosterone-producing adenoma (Conn's syndrome). PATIENTS AND METHODS: Between 1995 and 1999, seven patients with Conn's syndrome had laparoscopic adrenal-sparing resection of their tumors. These patients were followed up by means of radiology and biochemistry. RESULTS: All seven patients had successful laparoscopic surgery without complications. Most patients were discharged in 2 to 6 days (mean 3 days). At follow-up, the six patients investigated had normal blood pressure. No recurrences have been encountered with a median follow-up of 12 months in these six patients. CONCLUSIONS: Adrenal-sparing resection of tumors causing primary hyperaldosteronism is technically feasible by means of laparoscopy. This procedure has the advantage of keeping a greater reserve of normal adrenal tissue and of rapid postoperative recovery.     

Posterior retroperitoneoscopic partial nephrectomy using microwave tissue coagulator for small renal tumors

BACKGROUND AND PURPOSE: Laparoscopic partial nephrectomy remains surgically challenging because of the potential for excessive blood loss, infection, and the development of urinary fistulas. In addition, posterior retroperitoneoscopic partial nephrectomy is not popular because of the limited space for surgical manipulation. We evaluated the usefulness of a microwave tissue coagulator in posterior retroperitoneoscopic partial nephrectomy for small posterior renal tumor. PATIENTS AND METHODS: Posterior retroperitoneoscopic partial nephrectomy was performed without renal pedicle clamping using a microwave tissue coagulator in six patients with small posterior renal tumors. RESULTS: The mean operative time was 136 minutes (range 78-180 minutes), and the blood loss was <20 mL. No serious operative complications occurred, and there was no significant deterioration of renal function. CONCLUSION: Posterior retroperitoneoscopic partial nephrectomy using a microwave tissue coagulator can be a safe and less invasive method for the treatment of small posterior renal tumors.     

Posterior retroperitoneoscopic adrenalectomy for unilateral nodular hyperplasia in a hemodialaysis patient

We report a case of posterior retroperitoneoscopic adrenalectomy for unilateral nodular hyperplasia in a patient with chronic renal failure on hemodialysis. Posterior retroperitoneoscopic adreanlectomy appears to be a safe and valuable alternative for the treatment of the adrenal tumors in hemodialysis patients with easy tissue fragility and bleeding tendency. This revised version was published online in August 2006 with corrections to the Cover Date.     

超声刀与高频电刀在腹腔镜肾上腺肿瘤切除术应用中的比较

目的探讨超声刀在腹腔镜肾上腺肿瘤切除术中的应用。方法腹腔镜下采用高频电刀和超声刀进行。肾上腺肿瘤切除术,对比分析两组各项手术指标（手术时间、术中出血、输血例数、术中血压剧烈波动例数、中转开放例数、术后胃肠道功能恢复时间、术后起床活动时间、引流量、拔管时间、术后住院天数）之间的差别。结果超声刀组全部顺利完成腹腔镜肾上腺肿瘤切除术,而高频电刀组2例中转开放手术。与高频电刀组比较,超声刀组手术时间明显缩短（62．7±26．5minvs90．51±40．3min）,术中出血明显减少（30．8±3．28mlvs110．6±25．71ml）,术后排气时间及下床活动时间提前（1．1±0．3dvs2．0±0．6d）,术后引流量较少（12．6±7．2mlvs32．5±6．5）,术后住院时间缩短（5．5±2．15dvs7．0±2．5d）。术后随访6个月至5年,无肿瘤复发及残余肿瘤,肾上腺疾病临床症状、体征改善。结论超声刀在腹腔镜。肾上腺肿瘤切除术中具有止血确切、术野清晰、热传导低等优点,临床应用安全可靠。     

腹膜后腹腔镜肾上腺部分切除术与全切除术治疗醛固酮瘤的对比研究

目的 比较腹膜后腹腔镜肾上腺部分切除术与全切除术治疗肾上腺醛固酮瘤的治疗效果.方法 回顾性分析我院94 例醛固酮瘤临床资料.34 例行后腹腔镜下肾上腺全切除术,60 例行后腹腔镜下肾上腺部分切除术.术后随访6~60 个月,平均24.5 个月.结果 行肾上腺全切组手术时间(40.0±12.0)min,术中失血量(23.5±9.5)ml,拔引流管时间(2.5±1.2)d,肿瘤大小(20.0±5.0)mm,术后住院天数(6.5±2.0)d.行肾上腺部分切除组手术时间(48.0±13.0)min,术中失血量(25.5±10.0)ml,拔引流管时间(2.8±1.4)d;肿瘤大小(18.5±4.5)mm;术后住院天数(7.0±2.5)d.肾上腺全切除组和部分切除组的肿瘤大小、术中失血量、住院时间和拔引流管时间差异无统计学意义(P>0.05).全切除组手术时间短于部分切除组(P<0.05).全切组术和部分切除组术后有效率分别为100%(34/34)和96.7%(58/60),两组间差异无统计学意义(P>0.05).结论 单发肾上腺醛固酮瘤适合于肾上腺部分切除术,肿瘤多灶性是保留肾上腺组织手术治疗无效的主要原因.对于部分切除术治疗无效患者,再次行患侧肾上腺全切除或肿瘤切除均可获得良好疗效.     

Laparoscopic partial versus total adrenalectomy for aldosterone producing adenoma

Purpose:

Laparoscopic surgery has become a standard method for adrenal treatment. Primary hyperaldosteronism is known to be frequently characterized by multiple adrenal lesions. The indication of laparoscopic partial or total adrenalectomy in patients with aldosterone producing adenoma (APA) remains controversial. We performed the 2 procedures and compared the outcomes of these 2 operations retrospectively.

Materials and Methods:

A total of 92 patients with primary hyperaldosteronism were laparoscopically treated at our institution from 1995 to 2004. A total of 29 patients underwent partial adrenalectomy or enucleation, while unilateral total adrenalectomy was performed in 63. A single pathologist examined the number and histopathological characteristics of APAs. Postoperative median followup was 60.3 and 29.3 months, respectively.

Results:

Laparoscopic adrenalectomies were successfully performed in each group, although the partial type had fewer ports and shorter operative time. All 63 patients with total adrenalectomy showed recovery from hypertension, suppressed plasma renin activity and high plasma aldosterone. Two of 29 patients with partial adrenalectomy or enucleation still experienced hypertension with high plasma aldosterone. Of the 63 extirpated specimens 17 adrenals (27.0%) demonstrated multiple space occupying lesions along with the main APA.

Conclusions:

Primary hyperaldosteronism is highly associated with multiple adrenal space occupying lesions. The risk-to-benefit ratio must be carefully weighed against the potential advantage of partial adrenalectomy. We chose total laparoscopic adrenalectomy in patients with unilateral APA and primary hyperaldosteronism.     

腹腔镜行肾上腺部分切除术与全切术治疗肾上腺原醛瘤的比较:附235例报告

目的 探讨肾上腺部分切除术与全切术治疗腺瘤型原发性醛固酮增多症的效果.方法 回顾性分析235例腺瘤型原发性醛固酮增多症患者的临床资料.85例行后腹腔镜下肾上腺全切,150例行后腹腔镜下肾上腺部分切除.结果 行肾上腺部分切除组手术时间48.0±15.0 min;术中失血量25.0±10.0 ml;拔引流管时间2.2±1.0 d;术后住院天数7.0±2.5 d;病灶大小15.5±4.5 mm.行肾上腺全切组手术时间37.0±12.0 min;术中失血量23.0±9.0ml;拔引流管时间2.4±1.2 d;术后住院天数6.8±2.0 d;病灶大小16.0±3.0mm.部分切除组和全切组术中失血量、拔引流管时间、住院时间及病灶大小差异无统计学意义(P＞0.05).部分切除组手术时间长于全切组(P＜0.05).随访6个月～2年,所有患者血钾恢复正常,198例血压恢复正常.结论 对于单发醛固酮腺瘤的患者,行肾上腺部分切除术治疗腺瘤型原发性醛固酮增多症安全、有效,而且保留了部分有功能的肾上腺组织,优于肾上腺全切术.     

俯卧位背侧入路后腹腔镜肾上腺肿瘤切除术(附13例报告)

目的:探讨俯卧位背侧入路行后腹腔镜肾上腺肿瘤切除术的疗效及方法。方法:回顾分析2010年6月至2011年3月为13例患者行俯卧位经背侧入路后腹腔镜肾上腺手术的临床资料。其中男9例,女4例,35～57岁,平均45.3岁。术前均行超声、CT或MRI等检查证实为肾上腺占位性病变。病变位于左侧7例,右侧6例。原发性醛固酮增多症8例,嗜铬细胞瘤4例,无功能腺瘤1例。肿瘤直径1.3～4.2 cm,平均2.4 cm。结果:13例均顺利完成手术。手术时间65～125 min,平均89.5 min;术中出血量20～80 ml,平均45.6 ml;术后住院5～8 d,平均6.6 d。围手术期无并发症发生。随访5～14个月,平均10.5个月,未见肿瘤复发及转移。结论:俯卧位背侧入路行后腹腔镜肾上腺肿瘤切除术安全可行。经背侧入路为腹腔镜手术入路提供了新的选择。     

Mucosal proctectomy using an ultrasonic scalpel

Mucosal proctectomy is becoming the operation of choice in the surgical treatment of patients with ulcerative colitis and familial polyposis coli. Dissection of the rectal mucosa and submucosa from the underlying muscularis is often difficult and, in some instances, impossible to perform. The feasibility of using an ultrasonic device to perform mucosal protectomy was studied in eight dogs. This technique produced coagulative necrosis of the mucosa and muscularis mucosa with marked edema and congestion of the submucosa. The muscularis propria remained intact. Complete destruction of the distal 7 cm of rectal mucosa required a total duration of exposure to the ultrasonic probe of at least 12 minutes. In another five dogs, total colectomy was performed above the area of the mucosal proctectomy followed by endorectal pull-through of the ileum. Follow-up studies revealed healing of the ileonal anastomosis without retraction or stricture. This technique should allow mucosal proctectomy to be performed in those patients in whom standard dissection is not possible due to fibrosis of the submucosal plane.