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BMC Surgery
Published in: BMC Surgery 2/2013

Open Access 01-10-2013 | Research article

Laparoscopic adrenal surgery: ten-year experience in a single institution

Authors: Giovanni Conzo, Daniela Pasquali, Cristina Della Pietra, Salvatore Napolitano, Daniela Esposito, Sergio Iorio, Annamaria De Bellis, Giovanni Docimo, Fausto Ferraro, Luigi Santini, Antonio Agostino Sinisi

Published in: BMC Surgery | Special Issue 2/2013

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Abstract

Background

Minimal invasive adrenalectomy has become the procedure of choice to treat adrenal tumors with a benign appearance, ≤ 6 cm in diameter and weighing < 100 g. Authors evaluated medium- and long-term outcomes of laparoscopic adrenalectomy (LA), performed for ten years in a single endocrine surgery unit.

Methods

We retrospectively reviewed 88 consecutive patients undergone LA for lesions of adrenal glands from 2003 to 2013. The first 30 operations were considered part of the learning curve. Doxazosin was preoperatively administered in case of pheochromocytoma (PCC), while spironolactone and potassium were employed to treat Conn's disease. Perioperative cardiovascular status modifications and surgical and medium- and long-term results were analyzed.

Results

Forty nine (55.68%) functioning tumors, and one (1.13%) bilateral adrenal disease were identified. In 2 patients (2.27%) a supposed adrenal metastasis was postoperatively confirmed, while in no patients a diagnosis of incidental primitive malignancy was performed. There was no mortality or major post operative complication. The mean operative time was higher during the learning curve. Conversion and morbidity rates were respectively 1.13% and 5.7%. Intraoperative hypertensive crises (≥180/90 mmHg) were observed in 23.5% (4/17) of PCC patients and were treated pharmacologically with no aftermath. There was no influence of age, size and operative time on the occurrence of PCC intraoperative hypertensive episodes. Surgery determined a normalization of the endocrine profile. One single PCC persistence was observed, while in a Conn's patient, just undergone right LA, a left sparing adrenalectomy was performed for a contralateral metachronous aldosteronoma.

Conclusions

LA, a safe, effective and well tolerated procedure for the treatment of adrenal neoplasms ≤ 6 cm, is feasible for larger lesions, with a similar low morbidity rate. Operative time has improved along with the increase of the experience and of the technological development. Preoperative adrenergic blockade did not prevent PCC intraoperative hypertensive crises, but facilitated the control of the hemodynamic stability.
Literature
1.
Conzo G, Musella M, Corcione F, De Palma M, Avenia N, Milone M, Della Pietra C, Palazzo A, Parmeggiani D, Pasquali D, A Sinisi A, Santini L: Laparoscopic treatment of pheochromocytomas smaller or larger than 6 cm A clinical retrospective study on 44 patients. Laparoscopic adrenalectomy for pheochromocytoma. Ann Ital Chir. 2012, 84: 417-422.
2.
Toniato A, Boschin IM, Opocher G, Guolo A, Pelizzo M, Mantero F: Is the laparoscopic adrenalectomy for pheochromocytoma the best treatment?. Surgery. 2007, 141: 723-727. 10.1016/j.surg.2006.10.012.CrossRefPubMed
3.
Shen WT, Grogan R, Vriens M, Clark OH, Duh QY: One hundred two patients with pheochromocytoma treated at a single institution since the introduction of laparoscopic adrenalectomy. Arch Surg. 2010, 145 (9): 893-897. 10.1001/archsurg.2010.159. SepCrossRefPubMed
4.
Bittner JG, Gershuni VM, Matthews BD, Moley JF, Brunt LM: Risk factors affecting operative approach, conversion, and morbidity for adrenalectomy: a single-institution series of 402 patients. Surg Endosc. 2013, 7 (27): 2342-2350.CrossRef
5.
Sharma R, Ganpule A, Veeramani M, Sabnis RB, Desai M: Laparoscopic management of adrenal lesions larger than 5 cm in diameter. Urol J. 2009, 6 (4): 254-259. FallPubMed
6.
Lombardi CP, Raffaelli M, De Crea C, Traini E, D'Amore AM, Bellantone R: Pheochromocytoma: role of preoperative diagnosis in the assessment of malignancy risk and in the choice of surgical approach. Suppl Tumori. 2005, 4 (3): S211-May-JunPubMed
7.
Conzo G, Musella M, Corcione F, De Palma M, Ferraro F, Palazzo A, Napolitano S, Milone M, Pasquali D, Sinisi AA, Colantuoni V, Santini L: Laparoscopic adrenalectomy, a safe procedure for pheochromocytoma. A retrospective review of clinical series. Int J Surg. 2013, 11: 152-156. 10.1016/j.ijsu.2012.12.007.CrossRefPubMed
8.
Cheah WK, Clark OH, Horn JK, Siperstein AE, Duh QY: Laparoscopic adrenalectomy for pheochromocytoma. World J Surg. 2002, 26 (8): 1048-51. 10.1007/s00268-002-6669-x. AugCrossRefPubMed
9.
Li ML, Fitzgerald PA, Price DC, Norton JA: Iatrogenic pheochromocytomatosis: a previously unreported result of laparoscopic adrenalectomy. Surgery. 2001, 130 (6): 1072-1077. 10.1067/msy.2001.118373. DecCrossRefPubMed
10.
Murphy MM, Witkowski ER, Ng SC, McDade TP, Hill JS, Larkin AC, Whalen GF, Litwin DE, Tseng JF: Trends in adrenalectomy: a recent national review. Surg Endosc. 2010, 24 (19): 2518-2526.CrossRefPubMed
11.
Zhu Y, He HC, Su TW, Wu YX, Wang WQ, Zhao JP, Shen Z, Zhang CY, Rui WB, Zhou WL, Sun FK, Ning G: Selective α 1- adrenoceptor antagonist (controlled release tablets) in preoperative management of pheochromocytoma. Endocrine. 2010, 38 (2): 254-259. 10.1007/s12020-010-9381-x.CrossRefPubMed
12.
Park HS, Roman SA, Sosa JA: Outcomes from 3144 adrenalectomies in the United States: which matters more, surgeon volume or specialty?. Arch Surg. 2009, 144 (11): 1060-7. 10.1001/archsurg.2009.191. NovCrossRefPubMed
13.
Conzo G, Circelli L, Pasquali D, Sinisi A, Sabatino L, Accardo G, Renzullo A, Santini L, Salvatore F, Colantuoni V: Lessons to be learned from the clinical management of a MEN 2A patient bearing a novel 634/640/700 mutation of the RET proto-oncogene. Clin Endocrinol (Oxf). 2012, 77: 934-936. 10.1111/j.1365-2265.2012.04412.x.CrossRef
14.
Conzo G, Sciascia V, Palazzo A, Stanzione F, Della Pietra C, Insabato L, Natella V, Radice L, Santini L: Radiofrequency-assisted partial nephrectomy for metanephric adenoma: a case report and literature review. Surg Innov. 2013, 20 (1): 55-8. 10.1177/1553350612442792. FebCrossRefPubMed
15.
Conzo G, Pasquali D, Bellastella G, Esposito K, Carella C, De Bellis A, Docimo G, Klain M, Iorio S, Napolitano S, Palazzo A, Pizza A, Sinisi AA, Zampella E, Bellastella A, Santini L: Total thyroidectomy, without prophylactic central lymph node dissection, in the treatment of differentiated thyroid cancer. Clinical retrospective study on 221 cases. Endocrine. 2013, Epub ahead of print,
16.
De Bellis A, Conzo G, Cennamo G, Pane E, Bellastella G, Colella C, Iacovo AD, Paglionico VA, Sinisi AA, Wall JR, Bizzarro A, Bellastella A: Time course of Graves' ophthalmopathy after total thyroidectomy alone or followed by radioiodine therapy: a 2-year longitudinal study. Endocrine. 2012, 41: 320-326. 10.1007/s12020-011-9559-x.CrossRefPubMed
17.
De Santo RM, Esposito MG, Cesare CM, Cice G, Perna AF, Violetti E, Conzo G, Bilancio G, Celsi S, Annunziata F, Iannelli S, De Santo NG, Cirillo M, Livrea A: Parathyroidectomy improves the quality of sleep in maintenance hemodialysis patients with severe hyperparathyroidism. J Nephrol. 2008, 21 (Suppl 13): S92-6.PubMed
18.
Conzo G, Perna AF, Sinisi AA, Palazzo A, Stanzione F, Della Pietra C, Livrea A, et al: Total parathyroidectomy without autotransplantation in the surgical treatment of secondary hyperparathyroidism of chronic kidney disease. J Endocrinol Invest. 2012, 35: 8-13.PubMed
19.
Conzo G, Perna A, Avenia N, de Santo RM, Della Pietra C, Palazzo A, Sinisi AA, Stanzione F, Santini L: Evaluation of “putative” role of intraoperative intact parathyroid hormone assay during parathyroidectomy for secondary hyperparathyroidism. A retrospective study on 35 consecutive patients Endocrine. 2012, 42 (3): 606-611. DecPubMed
20.
Conzo G, Tricarico A, Belli G, Candela S, Corcione F, Del Genio G, Ferulano GP, Giardiello C, Livrea A, Marzano LA, Porcelli A, Sperlongano P, Vincenti R, Palazzo A, De Martino C, Musella M: Adrenal incidentalomas in the laparoscopic era and the role of correct surgical indications: observations from 255 consecutive adrenalectomies in an Italian series. Can J Surg. 2009, 52: E281-E285.PubMedCentralPubMed
21.
Zheng QY, Zhang GH, Zhang Y, Guo YL: Adrenalectomy may increase survival of patients with adrenal metastases. Oncol Lett. 2012, 3 (4): 917-920. Apr 1PubMedCentralPubMed
22.
Pasquali D, Rossi V, Conzo G, Pannone G, Bufo P, De Bellis A, Renzullo A, Bellastella G, Colao A, Vallone G, Bellastella A, Sinisi AA: Effects of somatostatin analog SOM230 on cell proliferation, apoptosis, and catecholamine levels in cultured pheochromocytoma cells. J Mol Endocrinol. 2008, 40: 263-271.PubMed
23.
Van der Horst-Schrivers, Kerstens MN, Wolffenbuttel BHR: Preoperative pharmacological management of phaeochromocytoma. The Netherlands Journal of Medicine. 2006, 64: 290-295.
24.
Tauzin-Fin P, Sesay M, Gosse P, Ballanger P: Effects of perioperative alpha1 block on haemodynamic control during laparoscopic surgery for pheochromocytoma. Br J Anaesth. 2004, 92 (4): 512-517. 10.1093/bja/aeh083.CrossRefPubMed
25.
Prys-Roberts C, Farndon JR: Efficacy and Safety of Doxazosin for Perioperative Management of Patients with Pheochromocytoma. World J Surg. 2002, 26: 1037-1042. 10.1007/s00268-002-6667-z.CrossRefPubMed
26.
Conzo G, Musella M, Corcione F, De Palma M, Stanzione F, Della Pietra C, Palazzo A, Napolitano S, Pasquali D, Milone M, Sinisi AA, Santini L: Role of preoperative adrenergic blockade with doxazosin on hemodynamic control during the surgical treatment of pheochromocytoma. A retrospective study of 48 cases. The American Surgeon. 2013, Epub ahead of print
27.
Assalia A, Gagner M: Laparoscopic adrenalectomy. Br J Surg. 2004, 91 (10): 1259-1274. 10.1002/bjs.4738. OctCrossRefPubMed
28.
Cotesta D, Petramala L, Serra V, Pergolini M, Crescenzi E, Zinnamosca L, De Toma G, Ciardi A, Carbone I, Massa R, Filetti S, Letizia C: Clinical experience with pheochromocytoma in a single centre over 16 years High Blood Press Cardiovasc Prev. 2009, 16 (4): 183-193. Dec
29.
Dalvi AN, Thapar PM, Thapar VB, Rege SA, Deshpande AA: Laparoscopic adrenalectomy for large tumours: Single team experience. J Minim Access Surg. 2012, 8 (4): 125-128. 10.4103/0972-9941.103110. Oct, doi: 10.4103/0972-9941.103110PubMedCentralCrossRefPubMed
30.
Prager G, Heinz-Peer G, Passler C, Kaczirek K, Scheuba C, Niederle B: Applicability of laparoscopic adrenalectomy in a prospective study in 150 consecutive patients. Arch Surg. 2004, 139 (1): 46-49. 10.1001/archsurg.139.1.46. JanCrossRefPubMed
31.
Lombardi CP, Raffaelli M, De Crea C, Boniardi M, De Toma G, Marzano LA, Miccoli P, Minni F, Morino M, Pelizzo MR, Pietrabissa A, Renda A, Valeri A, Bellantone R: Open versus endoscopic adrenalectomy in the treatment of localized (stage I/II) adrenocortical carcinoma: results of a multiinstitutional Italian survey. Surgery. 2012, 152 (6): 1158-1164. 10.1016/j.surg.2012.08.014. Dec, doi: 10.1016/j.surg.2012.08.014. Epub 2012 Oct 13CrossRefPubMed
32.
Lombardi CP, Raffaelli M, Boniardi M, De Toma G, Marzano LA, Miccoli P, Minni F, Morino M, Pelizzo MR, Pietrabissa A, Renda A, Valeri A, De Crea C, Bellantone R: Adrenocortical carcinoma: effect of hospital volume on patient outcome. Langenbecks Arch Surg. 2012, 397 (2): 201-207. 10.1007/s00423-011-0866-8. Feb, doi: 10.1007/s00423-011-0866-8. Epub 2011 Nov 9CrossRefPubMed
33.
Docimo G, Ruggiero R, Gubitosi A, Casalino G, Bosco A, Gili S, Conzo G, Docimo L: Ultrasound scalpel thyroidectomy: prospective randomized study. Ann Ital Chir. 2012, 83 (6): 491-496. Nov-DecPubMed
34.
Cirocchi R, Boselli C, Guarino S, Sanguinetti A, Trastulli S, Desiderio J, Santoro A, Rondelli F, Conzo G, Parmeggiani D, Noya G, De Toma G, Avenia N: Total thyroidectomy with ultrasonic dissector for cancer: multicentric experience. World J Surg Oncol. 2012, 10: 70-10.1186/1477-7819-10-70.PubMedCentralCrossRefPubMed
Metadata
Title
Laparoscopic adrenal surgery: ten-year experience in a single institution
Authors
Giovanni Conzo
Daniela Pasquali
Cristina Della Pietra
Salvatore Napolitano
Daniela Esposito
Sergio Iorio
Annamaria De Bellis
Giovanni Docimo
Fausto Ferraro
Luigi Santini
Antonio Agostino Sinisi
Publication date
01-10-2013
Publisher
BioMed Central
Published in
BMC Surgery / Issue Special Issue 2/2013
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/1471-2482-13-S2-S5

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