The risks of retroperitoneoscopic adrenalectomy
Authors:
P. Zonča; M. Peteja
; P. Vávra; V. Richter; P. Ostruszka
Authors place of work:
Chirurgická klinika, FN LF Ostravské univerzity
přednosta: doc. MUDr. P. Zonča, Ph. D., FRCS, MBA
Published in the journal:
Rozhl. Chir., 2017, roč. 96, č. 3, s. 130-133.
Category:
Case Report
Summary
Introduction:
Minimally invasive adrenalectomy has become the gold standard for surgery of the suprarenal gland. Retroperitoneoscopic adrenalectomy with dorsal approach is preferred. The aim of our case report is to discuss potential complications that may arise from retroperitoneoscopic adrenalectomy, specifically an intra-operative injury of the inferior vena cava.
Case report:
A 47-year-old male patient was admitted to undergo elective adrenalectomy on the right side. The reason for the surgery was a hormonally active adenoma with clinical signs of Conn’s syndrome. Biochemistry revealed the typical signs of hyperaldosteronism. A one-year history of unsuccessful treatment for hypertension was known. Ultrasound examination showed an enlarged suprarenal gland on the right side with the diameter of 5.2 cm. A CT scan confirmed the results of the ultrasound examination. Retroperitoneoscopic adrenalectomy was performed. The inferior vena cava was intraoperatively injured. The high pressure in the retroperitoneal space prevented bleeding. The injury to the vena cava was treated using a continuous stitch without the necessity of conversion to open surgery. The patient was discharged on the third postoperative day without any other complications.
Conclusions:
Retroperitoneoscopic approach is regarded by many authors as the new gold standard for adrenalectomy. However, very serious complications such as an injury of the inferior vena cava may occur. It is possible to treat this injury using retroperitoneoscopy. The risk of air embolization due to elevated pressure in the retroperitoneum (20 mm Hg) and open lumen of the IVC needs to be taken seriously.
Key words:
adrenalectomy – retroperitoneoscopy – complication
Zdroje
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Štítky
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