Introducing
Your new presentation assistant.
Refine, enhance, and tailor your content, source relevant images, and edit visuals quicker than ever before.
Trending searches
Author:
Sergio Rodrigo Pozo MD
Coauthors:
Marco A. Covarrubias Velásco MD
Adriana Y. Dávalos Casillas MD
Raul Vargas Ramírez MD
Jesús Raul Pérez Gomez MD
Hospital Country 2000, Guadalajara, Jalisco, México.
Indications for adrenalectomy
Functioning Tumors
- Aldosteronoma
- Cushing Syndrome * Cortisol Producing Adenoma
* Primary Adrenal Hyperplasia
* Failed treatment of pituitary Cushings
*Pheochromocytoma
- Non functionin cortical adenoma
* Large size (>5 cm) atypical appearance, enlargment
- Miscellaneous ( Myelolipomas, ganglioneuromas, cysts)
Non Functioning Tumors
Malignant Tumors
- Adrenal cortical carcinoma
- Malignant pheochromocytoma
Contraindicacions to Laparoscopic adrenalectomy
- Any tumor that appears locally invassive
- Need to perform regional lymphadenopathy or resect adjacent organs
Controversial in Laparoscopic adrenalectomy
- Large adrenal masses ( >10 cm)
- Primary adrenal malignancy
- Prior nephrectomy, splenectomy, or liver resection
A 54-year-old female patient
4-year history of severe episodes of migraine, peripheral vasospasm
and abdominal pain
With no relevant history, denies allergies, transfusions, or suffering from any condition or chronic degenerative
CT :Presence of left adrenal tumor round 8.3 x 9 x 6.9 cm with plane of separation from the left kidney,
Metanephrines in blood of 6,778 pg / mL.
Multidisciplinary
-Prehydratation
- Alfa-blocker
-Beta-Blocker
-Postoperative dose reduction hydrocortisone stress schedule
- Screening genetic Disorders
- Arterial catheter for patients
- Patient positioning, trocar distribution, dissection maneuvers, vascular ligation and extraction of the surgical specimen
- The histopathological examination confirmed the diagnosis of Pheochromocytoma with immunophenotype Syn +/ S100+ (Sustentacular) with proliferation index less than 1%.
- Patient was discharged at 48 hours completely asymptomatic, with any complications at the follow-up visits.
- The use of the hand-assisted device allows the removal of larger and more complex tumors. Plus an adequate management of structures and bleeding control.
-We prefer the transperitoneal approach due to the larger working space and greater orientation that this access usually provides.
-The management of pheochromocytoma requires the conviction that the key to success lies in an adequate preoperative preparation (pharmacological blockade) and having the appropriate material for the trans-surgery.
-Multidisciplinary approach, as well as collaboration between surgeons and anesthesiologists
-These measures, in addition to laparoscopy, have reduced the high morbimortality related to this surgery in the past.