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Publisher: Peytchinski, Gospodin Iliev
ISSN: 1312 773X (Online)
Issue: 2013, vol. 19, book 3;
Subject Collection: Medicine
Page: 461-464
DOI: 10.5272/jimab.2013193.461
Published online: 20 November 2013
J of IMAB. 2013 Jul-Dec;19(3):461-464
OUR EXPERIENCE IN LAPAROSCOPIC ADRENALECTOMY
Nikola Y. Kolev1, Valentin L. Ignatov1, Anton Y. Tonev1 
, Aleksandar K. Zlatarov1, Elitsa P. Encheva2, Tanya N. Kirilova1, Vasil M. Bojkov3, Krasimir D. Ivanov1.
1) Department of General and Operative Surgery, 2) Department of Nuclear Medicine, Metabolic Therapy and Radiotherapy, 3) Department of Surgical Diseases
University Hospital “St. Marina” Varna, Bulgaria, Medical University of Varna, Bulgaria.
ABSTRACT:
BACKGROUND: Laparoscopic adrenalectomy (LA) has become the procedure of choice to treat functioning and non-functioning adrenal tumours. With improving experience, large adrenal tumours (> 5 cm) are being successfully tackled by laparoscopy.
MATERIALS AND METHODS: Thirty-eight laparoscopic adrenalectomies was performed for adrenal lesions during the period 2006 to 2012 were reviewed.
RESULTS: A total of 35laparoscopic adrenalectomies were done in 32 patients. The mean tumour size was 5.03 cm (2-11 cm). The lesions were localised on the right side in 17 patients and on the left side in 15 patients, with bilateral tumours in 3 patients. Functioning tumours were present in 32 of the 46 patients. The average blood loss was 112 ml (20–400 ml) with the mean operating time being 144 min (45 to 270 min). Three patients underwent conversion to open procedure. Three of the 32 patients (9.52%) on final histology had malignant tumours.
CONCLUSION: LA is safe and feasible for large adrenal lesions. Mere size should not be considered as a contraindication to laparoscopic approach in large adrenal masses. Graded approach, good preoperative assessment, team work and adherence to anatomical and surgical principles are the key to success.
Key words: Laparoscopic adrenalectomy; adrenal tumour; large adrenal lesions; pheochromocytomas; aldosteronoma;
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Please cite this article as:
Kolev NY, Ignatov VL, Tonev AY, Zlatarov AK, Encheva EP, Kirilova TN, Bojkov VM, Ivanov KD. OUR EXPERIENCE IN LAPAROSCOPIC ADRENALECTOMY. J of IMAB. 2013 Jul-Dec;19(3):461-464. DOI: 10.5272/jimab.2013193.461.
Correspondence to: Anton Y. Tonev, University Hospital "St. Marina", Medical University of Varna; 1, Hristo Smirnenski Blvr., Varna, Bulgaria.; E-mail: teraton@abv.bg;
1. Gagner M, Lacroix A, Bolte E. Laparoscopic adrenalectomy in Cushing's syndrome and pheochromocytoma. N Engl J Med. 1992 Oct 1;327(14):1033. [PubMed] [CrossRef]
2. Shen TW, Sturgeon C, Duh QY. From incidentaloma to adrenocortical carcinoma: the surgical management of adrenal tumors. J Surg Oncol. 2005 Mar 1;89(3):186–92. [PubMed] [CrossRef]
3. Sturgeon C, Kebebew E. Laparoscopic adrenalectomy for malignancy. Surg Clin North Am. 2004 Jun;84(3):755–74. [PubMed] [CrossRef]
4. Prinz RA. A comparison of laparoscopic and open adrenalectomies. Arch Surg. 1995 May;130(5):489–92. [PubMed] [CrossRef]
5. Brunt LM, Doherty GM, Norton JA, Soper NJ, Quasebarth MA, Moley JF. Laparoscopic adrenalectomy compared to open adrenalectomy for benign adrenal neoplasms. J Am Coll Surg. 2004 Jul;183(1):1–10. [PubMed]
6. Jacobs JK, Goldstein RE, Geer RJ. Laparoscopic adrenalectomy.A new standard of care. Ann Surg. 2004 May;225(5):495–502. [PubMed]
7. Kebebew E, Siperstein AE, Duh QY. Laparoscopic adrenalectomy: the optimal surgical approach. J Laparoendosc Adv Surg Tech A. 2001 Dec;11(6):409–13. [PubMed] [CrossRef]
8. Gagner M, Pomp A, Heniford BT, Pharand D, Lacroix A. Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures. Ann Surg. 1997 Sep;226(3):238–46. [PubMed]
9. Assalia A, Gagner M. Laparoscopic adrenalectomy. Br J Surg. 2004 Oct;91(10):1259–74. [PubMed] [CrossRef]
10. Dalvi AN, Thapar PM, Vijay Kumar K, Kamble RS, Rege SA, Deshpande AA, et al. Laparoscopic adrenalectomy: Gaining experience by graded approach. J Minim Access Surg. 2006 Jun;2(2):59–66. [PubMed] [CrossRef]
11. Thornton JK. Abdominal nephrectomy for large sarcoma of the left suprarenal capsule: recovery. Trans Clin Soc Lond. 1890; 23:150–3.
12. Porpiglia F, Destefanis P, Fiori C, Giraudo G, Garrone C, Scarpa RM, et al. Does adrenal size really affect safety and effectiveness of laparoscopic adrenalectomy? Urology. 2002 Nov;60(5):801–5.[PubMed]
13. Novitsky YW, Czerniach DR, Kercher KW, Perugini RA, Kelly JJ, Litwin DE. Feasibility of laparoscopic adrenalectomy for large adrenal masses. Surg Laparosc Endosc Percutan Tech. 2003 Apr;13(2):106–10. [PubMed]
14. Ramacciato G, Mercantini P, La Torre M, Di Benedetto F, Ercolani G, Ravaioli M, et al. Is laparoscopic adrenalectomy safe and effective for adrenal masses larger than 7cm? Surg Endosc. 2008 Feb;22(2):516–21. [PubMed] [CrossRef]
15. Palazzo FF, Sebag F, Sierra M, Ippolito G, Souteyrand P, Henry JF. Long-term outcome following laparoscopic adrenalectomy for large solid adrenal cortex tumors. World J Surg. 2006 May;30(5):893–8. [PubMed] [CrossRef]
16. Rosoff JS, Raman JD, Del Pizzo JJ. Laparoscopic adrenalectomy for large adrenal masses. Curr Urol Rep. 2008 Jan;9(1):73–9. [PubMed]
17. Sharma R, Ganpule A, Veeramani M, Sabnis RB, Desai M. Laparoscopic management of adrenal lesions larger than 5 cm in diameter. Urol J. 2009 Fall;6(4):254–9. [PubMed]
18. Erbil Y, Barbaros U, Karaman G, Bozbora A, Ozarmağan S. The change in the principle of performing laparoscopic adrenalectomy from small to large masses. Int J Surg. 2009 Jun;7(3):266–71. [PubMed] [CrossRef]
19. Hemal AK, Singh A, Gupta NP. Whether adrenal mass more than 5 cm can pose problem in laparoscopic adrenalectomy? An evaluation of 22 patients. World J Urol. 2008 Oct;26(5):505–8. [PubMed] [CrossRef]
20. Papalia R, Simone G, Leonardo C, Loreto A, Coppola R, Guaglianone S, et al. Laparoscopic transperitoneal right adrenalectomy for ‘large’ tumors. Urol Int. 2008; 81(4):437–40. [PubMed] [CrossRef]
21. Zografos GN, Farfaras A, Vasiliadis G, Pappa T, Aggeli C, Vasilatou E, et al. Laparoscopic resection of large adrenal tumors. JSLS. 2010 Jul-Sep;14(3):364–8. [PubMed] [CrossRef]
22. Karanikola E, Tsigris C, Kontzoglou K, Nikiteas N. Laparoscopic adrenalectomy: where do we stand now? Tohoku J Exp Med. 2010 Apr;220(4):259–65. [PubMed] [CrossRef]
23. Kebebew E, Duh QY. Adrenal Incidentaloma. In: Cameron JL, editor. Current surgical therapy. Philadelphia: Elsevier Mosby; 2004. pp. 575–9.
24. Zografos GN, Vasiliadis G, Farfaras AN, Aggeli C, Digalakis M. Laparoscopic surgery for malignant adrenal tumors. JSLS. 2009 Apr-Jun;13(2):196–202. [PubMed]
25. Shen WT, Kebebew E, Clark OH, Duh QY. Reasons for conversion from laparoscopic to open or hand-assisted adrenalectomy: review of 261 laparoscopic adrenalectomies from 1993 to 2003. World J Surg. 2004 Nov;28(11):1176–9. [PubMed] [CrossRef]
26. Ramírez-Plaza CP, Rodríguez-Cañete A, Domínguez-López ME, Valle-Carbajo M, Jiménez-Mazure C, Marín-Camero N, et al. [Development and evolution of laparoscopic adrenalectomy in an specialized team: From the beginning to the outpatient setting] [in Spanish] Endocrinol Nutr. 2010; Jan;57(1):22–7. [PubMed] [CrossRef] .
Accepted for publication: 21 August 2013
Published online: 20 November 2013