PL EN


Preferencje help
Widoczny [Schowaj] Abstrakt
Liczba wyników
2008 | 80 | 9 | 446-454
Tytuł artykułu

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

Treść / Zawartość
Warianty tytułu
Języki publikacji
EN
Abstrakty
EN
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.Material and methods. A prospective analysis included 83 procedures of unilateral PRA (40 rightsided and 43 left-sided adrenalectomies) performed in patients (the M:F ratio = 22:61; mean age 58.1±10.3 years; mean tumor size 41±14 mm) operated on in the Department in the period from January 2004 to December 2007. Indications for surgery included: glucocorticoid adenomas (10), aldosteronomas (18), pheochromocytomas (16) and hormonally inactive adrenal cortex tumors (39). The operators used the PRA surgical technique according to Walz. The learning curve was evaluated taking into consideration the operative time, percentage of conversions and complications. The statistical analysis assessed the correlation between the operative time and body mass index (BMI), location and size of the tumor and its hormonal activity. The results of surgical treatment employed in patients with hormonally active tumors were evaluated in a 6-month follow-up.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.
Wydawca

Rocznik
Tom
80
Numer
9
Strony
446-454
Opis fizyczny
Daty
wydano
2008-09-01
online
2008-09-25
Twórcy
  • Department of Endocrine Surgery, 3 Chair of General Surgery, Jagiellonian University College of Medicine, Cracow
  • Department of Endocrine Surgery, 3 Chair of General Surgery, Jagiellonian University College of Medicine, Cracow
  • Department of Endocrine Surgery, 3 Chair of General Surgery, Jagiellonian University College of Medicine, Cracow
  • Chair and Department of Endocrinology, Jagiellonian University College of Medicine, Cracow
  • Chair and Department of Endocrinology, Jagiellonian University College of Medicine, Cracow
Bibliografia
  • Rubinstein M, Gill IS, Aron M et al.: Prospective, randomized comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy. J Urol 2005; 174: 442-45.
  • Viterbo R, Greenberg RE, Al-Saleem T et al.: Prior abdominal surgery and radiation do not complicate the retroperitoneoscopic approach to the kidney or adrenal gland. J Urol 2005; 174: 446-50.
  • Morris L, Ituarte P, Zarnegar R et al.: Laparoscopic adrenalectomy after prior abdominal surgery. World J Surg 2008; 32: 897-903.[WoS][PubMed][Crossref]
  • Prinz R: A comparison of laparoscopic and open adrenalectomies. Arch Surg 1995; 130: 786-87.
  • Gagner M, Lacroix A, Prinz RA et al.: Early experience with laparoscopic approach for adrenalectomy. Surgery 1993; 114: 1120-24.
  • Higashihara E, Tanaka Y, Horie S et al.: A case report of laparoscopic adrenalectomy. Nippon Hinyokika Gakkai Zasshi 1992; 327: 1130-33.
  • Kebebew E, Siperstein AE, Duh QY: Laparoscopic adrenalectomy: The optimal surgical approach. J Laparoendosc Adv Tech 2001; 11: 409-13.[Crossref]
  • Lezoche E, Guerrieri M, Feliciotti F et al.: Anterior, lateral, and posterior retroperitoneal approaches in endoscopic adrenalectomy. Surg Endosc 2002; 16: 96-99.[PubMed][Crossref]
  • Kalan MMH, Tillou G, Kulick A et al.: Preforming laparoscopic adrenalectomy safely. Arch Surg 2004; 139: 1243-47.
  • Walz MK, Peitgen K, Walz MV et al.: Posterior retroperitoneoscopic adrenalectomy: lessons learned within five years. World J Surg 2001; 25: 728-34.[Crossref][PubMed]
  • Henry JF, Defechereux T, Raffaelli M et al.: Complications of laparoscopic adrenalectomy: results of 169 consecutive procedures. World J Surg 2000; 24: 1342-46.[Crossref]
  • Solorzano CC, Lew JI, Wilhelm SM et al.: Outcomes of pheochromocytoma management in the laparoscopic era. Ann Surg Oncol 2007; 14: 3004-10.[PubMed][Crossref][WoS]
  • Fernandez-Cruz L, Saenz A, Taura P et al.: Retroperitoneal approach in laparoscopic adrenalectomy: is it advantageous? Surg Endosc 1999; 13: 86-90.
  • Baba S, Miyajima A, Uchida A et al.: A posterior lumbar approach for retroperitoneoscopic adrenalectomy: assessment of surgical efficacy. Urology 1997; 50: 19-24.[PubMed][Crossref]
  • Suzuki K, Kageyama S, Hirano Y et al.: Comparison of 3 surgical approaches to laparoscopic adrenalectomy: a nonrandomized, background matched analysis. J Urol 2001; 166: 437-43.
  • Yagisawa T, Ito F, Ishikawa N et al.: Retroperitoneoscopic adrenalectomy: lateral versus posterior approach. J Endourol 2004; 18: 661-64.[Crossref]
  • Bonjer HJ, van der Hast E, Steyeberg EW et al.: Retroperitoneal adrenalectomy: open or endoscopic? World J Surg 1998; 22: 1246-49.[Crossref]
  • Barczyński M, Konturek A, Gołkowski F et al.: Postrior retroperitoneoscopic adrenalectomy: A comparison between the initial experience in the invention phase and introductory phase of the new surgical technique. World J Surg 2007; 31: 65-71.[WoS]
  • Walz MK, Peitgen K, Krause U et al.: Die dorsale retroperitoneoscopische Adrenalektomie - eine neue operative Methode. Zentralbl Chir 1995; 120: 53.
  • Walz MK, Peitgen K, Hoermann R et al.: Posterior retroperitoneoscopy as a new minimally invasive approach for adrenalectomy: restults of 30 adrenalectomies in 27 patients. World J Surg 1996; 20: 769-74.[Crossref]
  • Walz MK, Peitgen K, Diesing D et al.: Partial versus total adrenalectomy by the posterior retroperitoneoscopic approach: early and long-term results of 325 consecutive procedures in primary adrenal neoplasias. World J Surg 2004; 28: 1323-29.[Crossref]
  • Walz MK, Petersenn S, Koch JA et al.: Endoscopic treatment of large primary adrenal tumours. Br J Surg 2005; 92: 719-23.
  • Tessier DJ, Iglesias R, Chapman WC et al.: Previously unreported high-grade complications of adrenalectomy. Surg Endosc 2008; Epub Apr 29.[WoS]
  • Kasperlik-Załuska AA, Otto M, Cichocki A et al.: 1,161 patients with adrenal incidentalomas: indications for surgery. Langenbeck's Arch Surg 2008; 391: 121-26.[WoS]
  • Babińska A, Sworczak K, Sekierska-Hellman M i wsp.: Przypadkowo wykryte guzy nadnerczy w Klinice Chorób Wewnętrznych, Endokrynologii i Zaburzeń Hemostazy, Akademii Medycznej w Gdańsku. Wiad Lek 2006; 59: 744-50.
  • Walz MK, Alesina PF, Wenger FA et al.: Posterior retroperitoneoscopic adrenalectomy - results of 560 procedures in 520 patients. Surgery 2006;140: 943-48.[PubMed]
  • Stanek A, Kowalczyk M, Kaska L et al.: One hundred and ten consecutive uncomplicated retroperitoneal videoscopic adrenalectomies - Polish multicentre study. Eur J Surg Oncol 2003; 29: 272-277.[Crossref]
  • Barczyński M, Konturek A, Cichoń S.: Lateral laparoscopic versus posterior retroperitoneoscopic adrenalectomy for adrenal tumors below 6 cm in diameter - a randomized study. 16th International Congress of the European Association of Endoscopic Surgeons (EAES), 11-15 June, 2008, Stockholm, Sweden. Streszcznie nr O68, str. 23.
  • Sapienza P, Cavallaro A: Persistent hypertension after removal of adrenal tumors. Eur J Surg 1999; 165: 187-92.
  • Harris DA, Au-Yong I, Basnyat PS et al.: Review of surgical management of aldosterone secreting tumours of the adrenal cortex. Eur J Surg Oncol 2003; 29: 467-74.[Crossref][PubMed]
  • Gagner M, Lacroix C, Bolte E: Laparoscopic adrenalectomy in Cushing's syndrome and pheochromocytoma. N Engl J Med 1992; 327: 1033-37.
Typ dokumentu
Bibliografia
Identyfikatory
Identyfikator YADDA
bwmeta1.element.-psjd-doi-10_2478_v10035-008-0065-7
JavaScript jest wyłączony w Twojej przeglądarce internetowej. Włącz go, a następnie odśwież stronę, aby móc w pełni z niej korzystać.