120 Laparoscopic Adrenalectomies with a Harmonic Scalpel

Česká verzia

Authors: M. Kasalický; M. Kršek ^*; T. Zelinka ^*; V. Hána ^*; J. Widimský ^*
Authors place of work: Chirurgická klinika 2. LF UK a ÚVN v Praze, přednosta: prof. MUDr. M. Ryska, CSc. ; III. interní klinika l. LF UK a VFN v Praze, přednosta: prof. MUDr. Š. Svačina, DrSc., MBA ^*
Published in the journal: Rozhl. Chir., 2009, roč. 88, č. 8, s. 439-443.
Category: Monothematic special - Original

Summary

Background:
Presently the laparoscopic adrenalectomy (LA) becomes most popular since 1992 when it was performed for the first time by laparoscopic method by Gagner. Typical indication for LA is the aldosteron-secreting adenoma, Cushing’s syndrome, feochromocytoma or scarcity tumors such as adrenal cyst or myelolipomas.

Aim:
The evaluation of the laparoscopic adrenalectomy as safe method for adrenals tumouťs extirpation to the sizes 10 cm.

Methods:
LA is provided with transperitoneal lateral approach most frequently then in back side position. Retroperitoneal approach is used less commonly.

Results:
Since 2006, firstly at the lst Surgical department of lst Medical School of Charles University and General Faculty Hospital and lastly at the Surgical department 2nd Medical School of Charles University and Central Military Hospital, has been performed on the whole 120 LA in 114 patients. The bilateral LA was performed in 6 patients. The conversion from the laparoscopic to open adrenalectomy was necessary by reason of the king size of the tumor (13/14 cm) in two cases. The lateral position and transperitoneal approach was used in all cases. The harmonie scalpel was ušed with advantage. Average length of the operation was 82 minutes (40–154 min), respective 180 minutes (130–270 min) in the case of the bilateral LA. The median size of the adrenal tumor was 4.9 cm (1.5–12.5 cm) with average weight 44 g (18–421 g). All of the patients after LA were monitored for 24 hours in the Intensive care units. The average time of the hospitalization was 3.7 days (2–6 days).

Conclusion:
Laparoscopic adrenalectomy presently becomes as the „gold standard“ for the treatment of adrenal tumors to the size 10 cm namely and in the event of malignancy. The harmonie scalpel is useful and sparing advice for the LA.

Key words:
laparoscopic adrenalectomy – transabdominal approach – adrenal tumors –harmonic scalpel

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