Topic: E. Clinical Pediatric Surgery/Transplantation/Endocrine/Plastics Surgery
Retroperitoneoscopic Adrenalectomy: Preferred Technique for Removal of Benign Tumors and Isolated Metastases
Nancy D Perrier, Debra L Kennamer, Ruijun Bao, Jeffrey E Lee, Douglas B Evans
MD Anderson Cancer Center, Houston, TX
The posterior retroperitoneoscopic adrenalectomy (RPA) is a minimally invasive approach to adrenal gland removal. This direct approach, recently popularized by Walz in Germany, minimizes dissection and affords early access to the adrenal vein. We report the largest experience of RPA to date in the United States.
A prospective adrenal database was used to capture patients who underwent RPA at a single tertiary care center between October 2005-2007. All RPA procedures were performed with a 3-trocar technique in the prone position with a dedicated anesthesiologist.
RPA was used to remove 57 adrenal glands in 52 patients. Indications for adrenalectomy included functional tumors in 36 cases(18 pheochromocytomas, 12 Cushing’s , 6 other), nonfunctional adenomas(2), and isolated adrenal metastasis(14). Median tumor size was 3.2cm (0.8 - 9.2 cm). Complications occurred in 6(12%) of 52 patients: exacerbation of preexisting SVC syndrome(1), respiratory distress(1), urinary retention(1), pneumothorax(1), bleeding(1) and tachycardia(1). In 40(76%) of 52 patients there was a relative contraindication to an anterior laparoscopic approach, including prior laparotomy [33(63%) of 52] and/or obesity [20(38%) of 52]. In this early experience, median operative time was only 122 minutes for unilateral cases, median hospital stay was 2 days.
CONCLUSIONS: RPA is safe, avoids intra-abdominal organ mobilization, is unaffected by the presence of intra-abdominal adhesions and may minimize technical difficulties related to obesity. Operative time and hospital stay were favorable, even in this early experience. RPA, until now performed only in Europe, may represent the preferred technique for removing benign adrenal tumors and isolated metastases.