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Content available remote Laparoscopic Adrenalectomy - Assessing the Learning Curve
Laparoscopic adrenalectomy (LA) has become the "gold standard" for treatment of most of adrenal tumors in last few years. It has many benefits comparing to open surgery, but still is considered as complicated procedure requiring experienced surgical team.The aim of the study was to assess the learning curve of laparoscopic adrenalectomy and the outcome of the first consecutive 154 LA.Material and methods. 154 consecutive patients undergoing LA between 2007 and 2010 were reviewed. Collected data included: patients demographics, clinical and histological diagnosis, side and length of operation, conversions to open surgery, complications and hospitalization time. Learning curve was evaluated by dividing all patients into three groups (group I - first 50 patients, group II - second 50 patients and group III last 54 patients). Differences between the groups were analyzed.Results. There were 154 LAs performed. Indications for LA were hormonally inactive adrenal adenoma(n=57), Conn's syndrome (n=30), Cushing's syndrome (n=28), pheochromocytoma (n=27), adrenal cyst (n=8), and others (n=4). Mean tumor size was 45.28 mm. There were 79 left-sided and 75 right-sided procedures and the average time of hospitalization was 4.64 days. Mean operative time was statistically different between the groups (216.2 min. - 164.6 min. - 131.9 min.; p<0.01) as well as the number of conversions to open surgery (18% - 4% - 3.7%; p=0.013). There was not any significant difference in the number of complications between analyzed groups (2% - 2% -3.7%).Conclusion. To improve the outcome of LA it is necessary to perform approximately 40 to 50 procedures.
Content available remote Videoscopic Extraperitoneal Operations of Suprarenal Glandules
An adrenal tumors are a clinical problem encountered by all health care providers go into endocrinological surgery. Nowadays the videoscopic adrenalectomy gains mounting acceptance. In the adrenal operations two kinds of operative access are used: an itraperitoneal and an extraperitoneal.The aim of the study was to analyse its own material and literature in purpose to find the answer if extraperitoneal access may be acknowledged as widely used method in adrenal tumor operations.Material and methods. 68 videoscopic adrenalectomy with extraperitoneal access were made in the Surgery Department of MSWiA Hospital in Łódź, between 2005 to 2007. The time of the operation, the time of the hospitalization, intraoperative blod loose, probability of complications, number and reasons of the conversies were taken into account.Results. In all the patients was performed complete tumor resection with adrenal gland. The diameter of removed tumors was between 4-14 cm. In 23 cases (33.8%), intraoperatively, during tumor preparation, the continuity of the peritoneum was broken however it didn't have any influence for the operation's proceedings and postoperative condition of the patients. Three conversions were made (4.4%). The average time of hospitalization was about 3.1 days. There weren't observed, in the postoperative period any wound suppurations or postoperative hernias.Conclusions. The own observations in confrontation with literature let find an extraperitoneal videoscopy as method with wide application in various size and origination in adrenal tumor operations.
Retroperitoneal bronchogenic cysts (BC) are rare clinical entities and may mimic an adrenal mass. Laparoscopic and retroperitoneoscopic approach is widely-used in adrenal surgery. However minimally- invasive resection of a periadrenally located BC has been reported rarely. Material and methods. A systematic review of PubMed has been performed using the following search strategy: bronchogenic cyst AND (adrenal OR retroperitoneal OR subdiaphragmatic). 18 BC being removed via minimally invasive approach have been found. Including our own case 7 were removed retroperitoneoscopically and 12 laparoscopically. Results. An index case of a 50 year old male is presented. CT revealed 2 masses above the left adrenal area. A control demonstrated an increase in size. Retroperitoneoscopic resection was performed. Pathologic finding showed a multilocular cystic lesion with a diameter of 4cm. The cysts were lined by pseudostratified ciliated epithelium. The wall contained hyaline cartilage, seromucous glands and smooth muscle. Conclusions. Because exact preoperative diagnosis of hormonally inactive adrenal masses is not possible surgical resection is recommended in case of tumor growth, symptoms and to obtain definitive histological diagnosis. Minimal invasive approach seems to be a safe way for resection of BC in experienced hands. There is no clear evidence if laparoscopic or retroperitoneoscopic approach is favourable
Content available remote Adrenal Tumors - Diagnostics and the Factual Situation
The study presented three cases of patients diagnosed with adrenal tumors subject to surgical intervention during the past 6 months in our Department. The patients presented with radiological diagnostic difficulties, as to the character and location of the primary tumor.The aim of the study was to demonstrate differences between radiological examination results and the factual situation observed during the adrenalectomy. In all the presented cases patients' were subject to laparoscopic intervention. In two cases conversion to open surgery was necessary. The histopathological results of the surgically removed samples were as follows: leiomyoma, myoperycytoma and pheochromocytoma. In selected cases imaging examinations might be of limited value, especially when determining the character and location of the primary lesion of the adrenal gland.
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