Functional Results After Endoscopic Subtotal Cortical-Sparing Adrenalectomy |
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Authors: | Michael Brauckhoff Phuong Nguyen Thanh Oliver Gimm Annett Bär Katrin Brauckhoff Henning Dralle |
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Institution: | Department of General, Visceral, and Vascular Surgery, Martin-Luther-University Halle/Wittenberg, Ernst-Grube-Strasse 40, 06097 Halle/Saale, Germany. |
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Abstract: | Purpose: We examined the required amount of residual adrenal tissue and whether an intact adrenal vein are necessary to achieve sufficient
function after endoscopic subtotal adrenalectomy.
Method: Endoscopic subtotal adrenalectomy was performed in 14 patients. Two patients underwent unilateral subtotal and contralateral
total adrenalectomy and another two patients underwent unilateral subtotal adrenalectomy after contralateral total adrenalectomy
several years earlier. We analyzed the postoperative serum levels of cortisol and adrenocorticotropic hormone (ACTH). Patients
with bilateral tumors underwent an ACTH test.
Results: We had to cut the main adrenal vein in ten patients, and less than one third of the adrenal gland was left in situ in four
patients. Subtotal adrenalectomy was performed unilaterally in two patients with bilateral tumors. One third of the adrenal
gland was preserved in these patients, and also in the two patients with unilateral subtotal adrenalectomy after previous
contralateral total adrenalectomy. The postoperative ACTH test confirmed satisfactory adrenocortical function. During the
follow-up period of about 24 months no recurrent tumors have been found.
Conclusion: Subtotal cortical-sparing adrenalectomy can be successfully performed laparoscopically. The venous drainage of the main adrenal
vein does not seem to be crucial for sufficient adrenocortical function. We estimate that leaving about one third of the entire
adrenal gland as remnant adrenal tissue will result in sufficient function.
Received: March 25, 2002 / Accepted: September 3, 2002
Reprint requests to: M. Brauckhoff |
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Keywords: | Laparoscopic adrenalectomy Subtotal adrenalectomy Cortical-sparing adrenalectomy |
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