Perioperative results of 214 laparoscopic adrenalectomies by anterior transperitoneal approach.
ABSTRACT The present study attempts to evaluate the perioperative results of the anterior approached laparoscopic adrenalectomy (LA) in a large cohort of patients, and report the advantages and disadvantages of this route.
204 patients, 125 female and 79 male with a mean age 52.8 years (range, 19-75 years), underwent LA by the anterior transperitoneal approach from 1994 to 2005 in our institution. There were 100 right and 114 left LAs. Ten patients underwent bilateral LA. Associated surgical procedures were performed in 17 cases. During the same period 47 LAs had been performed by different approaches (flank and submesocolic).
Mean operative time was 80 minutes for right (40-150), 109 minutes for left (64-300) and 194 minutes for bilateral adrenalectomy. Intraoperative major complications were observed in six patients. Mortality occurred in one diabetic patient who was converted to open surgery because of a colonic perforation and subsequently developed a Candida sepsis in the postoperative course. The mean size of lesion removed was 6.2 cm (1.5-12 cm). Oral intake started within 24 hours and the mean hospital stay was 2.5 days (1-8 days). Histology results were as follows: nonsecreting adenoma 65, Cushing's adenoma 58, Conn's adenoma 53, pheochromocytoma 24, metastases 9, myelolipoma 3, adrenogenital syndrome 1, carcinoma 1.
LA by anterior transperitoneal approach is safe and effective in our experience, despite the inherent limitation that this was not a prospective randomized study. The main advantage of this route is early ligature of the adrenal vein on both sides, enabling the performance of associated surgical procedures and bilateral adrenalectomy.
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ABSTRACT: ZET Laparoskopik adrenalektomi birçok adrenal hastalkta standart tedavi yöntemi olarak açk cerrahinin yerini almtr. Bu klinik çalmamzda ilk 5 laparoskopik adrenalektomi vakalarmz sunulmaktadr. Ocak ve Nisan 2008 tarihleri arasnda 5 hastaya transpe-ritoneal yol ile standart laparoskopik adrenalektomi uyguland. Preoperatif olarak tüm adrenal kitleler abdo-minal ultrasonografi ve abdominal bilgisayarl tomografi ile görüntülendi. Hastalarn kanlarnda serum dopamin, ACTH, aldosteron, kortizol, epinefrin, norepinefrin sevi-yeleri ve 24 saatlik idrarlarnda 5-HIAA, metanefrin, homovalinik asit, vanil mandelik asit, adrenalin ve noradrenalin düzeyleri ölçüldü. Hastalardan 3'ünde feok-romasitoma, 1 hastada adrenal adenom ve 1 hastada böbrek tümörünün kontrlateral adrenale metastaz tans ile adrenalektomi endikasyonu konuldu. Laparoskopik adrenalektominin cerrahi parametreleri ve fonksiyonel ksa dönem sonuçlar bu çalmada bildirildi. Adrenal kitlelerden 3 tanesi sada, 2 tanesi solda bulu-nuyordu. Hastalarn 3'ü bayan, 2'si erkek olup ya ortalamalar 60,5 (38-64) idi. Operasyon süresi ortalama 115 (100-120) dakika olarak kaydedildi. Ortalama kana-ma miktar 90 ml olarak saptand. Postoperatif 1. gün tüm hastalar taburcu edildi. Hastalarn hiçbirine transfüzyon uygulanmad. Hastalarda komplikasyon gelimedi ve açk cerrahiye dönülmedi. lk be olgu eliindeki snrl say ile elde ettiimiz veriler göstermektedir ki, transperitoneal yaklamla uygulanan laparoskopik adrenalektomi üroloji pratiinde uygulanabilir bir yöntemdir. Laparoskopik adrenalektomi sonras uzun dönem sonuçlarnn ortaya konmas ve vaka saysnn artmas ile daha güvenilir bilgiler elde edilebilecektir. ABSTRACT Laparoscopic adrenalectomy: Our first experiences with five patients Laparoscopic adrenalectomy as standard treatment method for adrenal diseases has taken the place of open surgery. The first 5 cases of laparoscopic adrenalectomy have been presented in this study. The standard transperitoneal laparoscopic adrenalectomy was performed in 5 patients between January–April 2008. All adrenal masses had been shown preoperatively by abdominal ultrasonography and computed tomography. Serum dopamin, ACTH, aldosteron, cortisol, epinefrin, norepinefrin levels were measured in blood tests and urinary metabolites (5-HIAA, metanefrin, homovalinic acide, vanil mandelik acide, adrenalin and noradrenalin) were measured in 24 hours urine tests. The posto-perative pathological diagnoses were pheocromacytoma in 3 patients, adrenal adenoma in 1 patient and contra-lateral kidney tumor metastasis in 1 patient. The results of laparascopic adrenalectomy (surgical parameters and short-time results) were reported in this study. The 3 adrenal masses were in right side and 2 were in left side. Three patients were women and 2 patients were men and mean age was 60.5 (38-64) years. Mean operation time was recorded as 115 (100-120) minutes. Mean bleeding volume was 90 ml. All patients were discharged in 1. postoperative day. None of the patients required blood transfusion. There was no complication and in none of the patients was returned to the open surgery. Obtained data with by the limited number of the first five cases showed that transperitoneal laparoscopic adrena-lectomy may be an acceptable technique in urology practice. With long-term results of laparoscopic adrenalectomy and by increasing the case number more reliable information can be obtained.Yeni Tıp Dergisi. 01/2009; 26:172-175.