Wyniki wyszukiwania - Biblioteka Nauki

1

Over 10 Years of Experience in the Laparoscopic Treatment of Adrenal Lesions via Lateral Transperitoneal Approach

100%

Otto M. , Dzwonkowski J. , Ciąćka T. , Jędrasik M.

Polish Journal of Surgery

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2008

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tom 80

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nr 9

478-486

EN

The aim of the study was to present own experience in the treatment of adrenal pathology using laparoscopic adrenalectomy (LA) via lateral transperitoneal approach.Material and methods. From 29.10.1997 to 30.04.2008 in the Department of General, Vascular and Transplant Surgery of Warsaw Medical University 417 LA have been performed in 405 patients. The indications were 195 (48%) non-functioning incidentaloma type tumors and 210 (52%) functioning tumors. Among them hypercortisolism in 66 (31.5%) patients (Cushing's disease - 3, Cushing's syndrome -28, subclinical Cushing's syndrome - 35), pheochromocytoma in 82 (39%), Conn's syndrome in 61 (29%) and adrenogenital syndrome in 1 (0.5%). There where 288 (71%) women and 117 (29%) men with the mean age of 51.8 years. The mean size of adrenal tumor was 41.1 mm. In 62 (15%) bilateral lesions were noted. All patients were operated laparoscopically via lateral transabdominal approach.Results. LA was successful in 393 patients (97%). We performed 393 (97%) unilateral LA, 10 (2.5%) bilateral simultaneous LA, 2 (0.5%) bilateral two-staged LA and also 2 (0.5%) sparing LA. 12 (3%) patients underwent simultaneous LA with laparoscopic cholecystectomy due to symptomatic cholecystolithiasis and 2 (0,5%) with laparoscopic umbilical hernioplasty. 12 (3%) conversions were necessary. 15 (3.7%) complications occurred, 3 (0.7%) intraoperative and 12 (3%) postoperative. There was 1 remote death on the 56th postoperative day.Conclusions. 1. LA should be recognize as the referential method in the treatment of adrenal pathology. 2. Results, as well as avoiding unnecessary complications and intraoperative difficulties is possible thanks to: close cooperation with the endocrinologist, experience gained from performing other laparoscopic operations, experience got at making open adrenalectomies.

2

Qualification and Operative Difficulties of Laparoscopic Adrenalectomy

75%

Otto M. , Dzwonkowski J. , Jędrasik M. , Ciąćka T. , Górnicka B. , Życińska K. , Szmidt J.

Polish Journal of Surgery

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2010

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tom 82

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nr 1

38-46

EN

Laparoscopic adrenalectomy (LA) became referential in the treatment of adrenal pathology. However in the majority of tumors biochemical markers and imaging examinations aren't reliable to evaluate existences of the malignant process before the operation. Therefore complete resection of the adrenal gland, without damaging the capsule of the tumor remains as a significant problem.The aim of the study was to introduce the problem involving the qualification of the patients for laparoscopic adrenalectomy, and concerning the post-operative histopathologic evaluation, as well as technical aspects of the conducted laparoscopy.Material and methods. These problems are being discussed based on our experience in laparoscopic adrenalectomy. In the period 29.10.1997 - 31.01.2009 472 laparoscopic adrenalectromies were carried out via lateral transperitoneal approach. Among 457 operated patients in 13 (2.8%) conversion was necessary.Results. The malignant lesions were in 22 (4.8%) patients. 11 (2.4%) had metastases from other origin, 1 (0.2%) had Cushing's syndrome and 3 (0.6%) had pheochromocytomas. In the incidentaloma group 6 (13.1%) primary ardenocortical carcinoma and 1 (0.2%) angiosarcoma were identified.Conclusions. Laparoscopic adrenalectomy via lateral transperitoneal approach is a sufficient and safe surgical treatment of adrenal pathology.

3

Hypertension Crisis in Adrenal Surgery and Treatment of Postoperative Hypotension

63%

Otto M. , Dzwonkowski J. , Januszewicz A. , Pęczkowska M. , Kański A. , Kasperlik-Załuska A. , Rosłonowska E. , Szmidt J.

Polish Journal of Surgery

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2010

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tom 82

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nr 4

199-211

EN

The aim of the study was to present our experience in the treatment of pheochromocytoma, which can have untypical manifestations or their complete lack. Surgery still is the main treatment. Since introducing minimally invasive method the operative choice between open and videoscopic still remains.The proper diagnosis, preparation and surgical treatment allow to avoid serious cardiovascular complications. In the treatment, pre-or intraoperative hypertensive crisis and hypotension appearing after removing the tumor are the important issues. Based on our study from 29.10.1997 to 31.01.2009 authors are showing methods and principles of preparation and the intra- and post-operative complications associated with performed operation.Additionally the problem of pheochromocytomas, clinically asymptomatic, so-called silent pheochromocytoma is discussed. Evaluated material consisted of 125 patients with pheochromocytoma. 32 (25,6%) were operated by open, classical method, and 93 (74.4%) laparoscopically via lateral transperitoneal approach.Conclusions. 1. The course and the result of surgical treatment of pheochromocytomas depend on proper diagnosis and preoperative preparation. 2. Laparoscopic adrenalectomy through lateral transperitoneal approach should be acknowledge as the referential operation in the treatment of pheochromocytoma. 3. Clinically asymptomatic pheochromocytoma require routine preparation similarly to other forms of pheochromocytoma.

4

Hypertension Crisis in Adrenal Surgery and Treatment of Postoperative Hypotension

63%

Otto M. , Dzwonkowski J. , Januszewicz A. , Pęczkowska M. , Kański A. , Kasperlik-Załuska A. , Rosłonowska E. , Szmidt J.

Polish Journal of Surgery

|

2010

|

tom 82

|

nr 4

199-211

EN

The aim of the study was to present our experience in the treatment of pheochromocytoma, which can have untypical manifestations or their complete lack. Surgery still is the main treatment. Since introducing minimally invasive method the operative choice between open and videoscopic still remains.The proper diagnosis, preparation and surgical treatment allow to avoid serious cardiovascular complications. In the treatment, pre-or intraoperative hypertensive crisis and hypotension appearing after removing the tumor are the important issues. Based on our study from 29.10.1997 to 31.01.2009 authors are showing methods and principles of preparation and the intra- and post-operative complications associated with performed operation.Additionally the problem of pheochromocytomas, clinically asymptomatic, so-called silent pheochromocytoma is discussed. Evaluated material consisted of 125 patients with pheochromocytoma. 32 (25,6%) were operated by open, classical method, and 93 (74.4%) laparoscopically via lateral transperitoneal approach.Conclusions. 1. The course and the result of surgical treatment of pheochromocytomas depend on proper diagnosis and preoperative preparation. 2. Laparoscopic adrenalectomy through lateral transperitoneal approach should be acknowledge as the referential operation in the treatment of pheochromocytoma. 3. Clinically asymptomatic pheochromocytoma require routine preparation similarly to other forms of pheochromocytoma.