Abstract
Adrenalectomy has become the standard of care for the management of hormonally active adrenal masses. Various surgical therapies have been proposed to excise completely or destroy these adrenal lesions, which may be benign or malignant. New minimally invasive, adrenal-sparing procedures have recently been introduced, among them laparoscopic partial adrenalectomy, cryosurgery, and radiofrequency ablation. These procedures focus on reducing patient morbidity and hastening postoperative recovery while preserving normal adrenal tissue. However, questions remain about the risks and benefits associated with routine application of minimally invasive therapies for adrenal-sparing surgery in terms of complete tumor extirpation. Clearly, more experience and longer follow-up is necessary to validate these procedures. Herein we describe the surgical techniques and early results of treatment with adrenal-sparing surgery.
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Gagner M, Lacroix A, Bolte E: Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 1992, 327:1033.
Gagner M, Lacroix A, Prinz RA, et al.: Early experience with laparoscopic approach for adrenalectomy. Surgery 1993, 114:1120–1124.
Naito S, Uozumi J, Shimura H, et al.: Laparoscopic adrenalectomy: review of 14 cases and comparison with open adrenalectomy. J Endourol 1995, 9:491–495.
Lucon AM, Mendonca BB, Domenice S, et al.: Adrenal autografts following bilateral adrenalectomy. J Urol 1993, 149:977–979.
Nakada T, Kubota Y, Sasagawa I, et al.: Therapeutic outcome of primary aldosteronism: adrenalectomy versus enucleation of aldosterone-producing adenoma. J Urol 1995, 153:1775–1780.
Irvin GL, Fishman LM, Sher JA: Familial pheochromocytoma. Surgery 1983, 94:938–940.
Van Heerden JA, Sizemore GW, Carney JA, et al.: Bilateral subtotal adrenal resection of bilateral pheochromocytomas in multiple endocrine neoplasia, type IIa: a case report. Surgery 1985, 98:363–366.
Birnbaum J, Giuliano A, Van Herle AJ: Partial adrenalectomy for pheochromocytoma with maintenance of adrenocortical function. J Clin Endocrinol Metab 1989, 69:1078–1081.
Lee JE, Curley SA, Gagel RF, et al.: Cortical-sparing adrenalectomy for patients with bilateral pheochromocytoma. Surgery 1996, 120:1064–1070.
Walther MM, Keiser HR, Choyke PL, et al.: Management of hereditary pheochromocytoma in von Hippel-Lindau kindreds with partial adrenalectomy. J Urol 1999, 161:395–398.
Janetschek G, Finkenstedt G, Gasser R, et al.: Laparoscopic surgery for pheochromocytoma: adrenalectomy, partial resection, excision of paragangliomas. J Urol 1998, 160:330–334.
Gross MD, Shapiro B, Freitas JE, et al.: Clinical significance of the solitary functioning adrenal gland. J Nucl Med 1991, 32:1882–1887.
Janetschek G, Lhotta K, Gasser R, et al.: Adrenal-sparing laparoscopic surgery for aldosterone-producing adenoma. J Endourol 1997, 11:145–148.
Al-Sobhi S, Peschel R, Bartsch G, et al.: Partial laparoscopic adrenalectomy for aldosterone-producing adenoma: short- and long-term results. J Endourol 2000, 14:497–499.
Sasagawa I, Suzuki H, Izumi T, et al.: Posterior retroperitoneoscopic partial adrenalectomy using ultrasonic scalpel for aldosterone-producing adenoma. J Endourol 2000, 14:573–576.
Ishikawa T, Inaba M, Nishiguchi Y, et al.: Laparoscopic adrenalectomy for benign adrenal tumors. Biomed Pharmacother 2000, 54(Suppl 1):183s-186s.
Kok KY, Yapp SK: Laparoscopic adrenal-sparing surgery for primary hyperaldosteronism due to aldosterone-producing adenoma. Surg Endosc 2002, 16:108–111.
Vaughan ED Jr, Blumenfeld JD: Adrenal glands. In Campbell’s Urology, edn 7. Edited by Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ. Philadelphia: WB Saunders; 1997:2915–2972.
Ross NA, Aron DC: Hormonal evaluation of the patient with an incidentally discovered adrenal mass. N Engl J Med 1990, 323:1401–1405.
Thompson NW, Cheung PSY: Diagnosis and treatment of functioning and nonfunctioning adrenocortical neoplasms including incidentalomas. Surg Clin North Am 1987, 67:423–436.
Aso Y, Homma Y: A survey on incidental adrenal tumors in Japan. J Urol 1992, 147:1479–1481.
Radmayr C, Neumann H, Bartsch G, et al.: Laparoscopic partial adrenalectomy for bilateral pheochromocytomas in a boy with von Hippel-Lindau disease. Eur Urol 2000, 38:344–348.
Neumann HP, Reincke M, Bender BU, et al.: Preserved adrenocortical function after laparoscopic bilateral adrenal sparing surgery for hereditary pheochromocytoma. J Clin Endocrinol Metab 1999, 84:2608–2610.
Pacak K, Linehan WM, Eisenhofer G, et al.: Recent advances in genetics, diagnosis, localization, and treatment of pheochromocytoma. Ann Intern Med 2001, 134:315–329.
Walther MM, Herring J, Choyke PL, Linehan WM: Laparoscopic partial adrenalectomy in patients with hereditary forms of pheochromocytoma. J Urol 2000, 164:14–17.
Mugiya S, Suzuki K, Saisu K, Fujita K: Unilateral laparoscopic adrenalectomy followed by contralateral retroperitoneoscopic partial adrenalectomy in a patient with multiple endocrine neoplasia type 2a syndrome. J Endourol 1999, 13:99–104.
Al-Sobhi S, Peschel R, Zihak C, et al.: Laparoscopic partial adrenalectomy for recurrent pheochromocytoma after open partial adrenalectomy in von Hippel-Lindau disease. J Endourol 2002, 16:171–174.
Heniford BT, Iannitti DA, Hale J, Gagner M: The role of intraoperative ultrasonography during laparoscopic adrenalectomy. Surgery 1997, 122:1068–1073.
Suzuki K, Sugiyama T, Saisu K, et al.: Retroperitoneoscopic partial adrenalectomy for aldosterone-producing adenoma using an ultrasonically activated scalpel. Br J Urol 1998, 82:138–139.
Sasagawa I, Suzuki H, Tateno T, et al.: Retroperitoneoscopic partial adrenalectomy using an endoscopic stapling device in patients with adrenal tumor. Urol Int 1998, 61:101–103.
Imai T, Tanaka Y, Kikumori T, et al.: Laparoscopic partial adrenalectomy. Surg Endosc 1999, 13:343–345.
Bonney WW, Fallon B, Gerber WL, et al.: Cryosurgery in prostatic cancer: elimination of local lesion. Urology 1983, 22:8–15.
Walsh DA, Maiwand MO, Nath AR, et al.: Bronchoscopic cryotherapy for advanced bronchial carcinoma. Thorax 1990, 45:509–513.
Rand RW, Rand RP, Eggerding FA, et al.: Cryolumpectomy for breast cancer: an experimental study. Cryobiology 1985, 22:307–318.
Gage AA: Cryosurgery for oral and pharyngeal carcinoma. Am J Surg 1969, 118:669–672.
Shafir M, Shapiro R, Sung M, et al.: Cryoablation of unresectable malignant liver tumors. Am J Surg 1996, 171:27–31.
Gill IS, Novick AC, Soble JJ, et al.: Laparoscopic renal cryoablation: initial clinical series. Urology 1998, 52:543–551. This initial clinical report demonstrates the technique and feasibility of renal cryoablation via a retroperitoneal laparoscopic approach in 10 patients with exophytic renal lesions measuring 1.5 to 3 cm in size.
Schulsinger DA, Sosa RE, Perlmutter AP, Vaughan ED Jr: Acute and chronic interstitial cryotherapy of the adrenal gland as a treatment modality. J Endourol 1999, 13:299–303. This animal study is the first reported series in which modern cryoablation technology was applied to the adrenal gland for the purpose of organ preservation. The results demonstrate that cryoablation is an efficient energy form that can be used in a controlled and reproducible manner via an open or laparoscopic surgical approach.
Chosy SG, Nakada SY, Lee FT Jr, Warner TF: Monitoring renal cryosurgery: predictors of tissue necrosis in swine. J Urol 1998, 159:1370–1374. This report demonstrated complete and homogeneous histopathologic necrosis of renal tissues at temperatures below -19.4° C and at distances within 16 mm from the cryosurgical probe.
Baust J, Gage AA, Ma H, Zhang CM: Minimally invasive cryosurgery--technological advances. Cryobiology 1997, 34:373–384.
Curley SA, Izzo F, Delrio P, et al.: Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies: results in 123 patients. Ann Surg 1999, 230:1–8.
Wood BJ, Bates S: Radiofrequency thermal ablation of a splenic metastasis. J Vasc Interv Radiol 2001, 12:261–263.
Dupuy DE, Zagoria RJ, Akerley W, et al.: Percutaneous radiofrequency ablation of malignancies in the lung. AJR Am J Roentgenol 2000, 174:57–59.
Tillotson CL, Rosenberg AE, Rosenthal DI: Controlled thermal injury of bone. Report of a percutaneous technique using radiofrequency electrode and generator. Invest Radiol 1989, 24:888–892.
Jeffrey SS, Birdwell RL, Ikeda DM, et al.: Radiofrequency ablation of breast cancer: first report of an emerging technology. Arch Surg 1999, 134:1064–1068.
Zlotta AR, Djavan B, Matos C, et al.: Percutaneous transperineal radiofrequency ablation of prostate tumour: safety, feasibility and pathological effects on human prostate cancer. Br J Urol 1998, 81:265–275.
McGovern FJ, Wood BJ, Goldberg SN, Mueller PR: Radiofrequency ablation of renal cell carcinoma via image guided needle electrodes. J Urol 1999, 161:599–600.
Pautler SE, Pavlovich CP, Mikityansky I, et al.: Retroperitoneoscopic-guided radiofrequency ablation of renal tumors. Can J Urol 2001, 8:1330–1333. This is a report of a patient treated with retroperitoneoscopic RF ablation of two left renal tumors. The short-term efficacy of this therapy was suggested by a 5-month follow-up computed tomogaphy scan that revealed no contrast enhancement of either renal lesion.
Reddan DV, Raj GV, Polascik TJ: Management of small renal tumors: an overview. Am J Med 2001, 110:558–562.
Hoey MF, Mulier PM, Leveillee RJ, Hulbert JC: Transurethral prostate ablation with saline electrode allows controlled production of larger lesions than conventional methods. J Endourol 1997, 11:279–284.
Abraham J, Fojo T, Wood BJ: Radiofrequency ablation of metastatic lesions in adrenocortical cancer. Ann Intern Med 2000, 133:312–313. This is one of few reports describing the use of percutaneous RF ablation to treat four patients with metastatic adrenocortical carcinoma. Four to 8 weeks after the procedure the lesions were smaller, nonenhancing, or had completely disappeared. The authors suggest that with durable responses, this procedure may prolong survival in patients with metastatic adrenal carcinoma.
Dupuy DE, Goldberg SN: Image-guided radiofrequency tumor ablation: challenges and opportunities - part II. J Vasc Interv Radiol 2001, 12:1135–1148.
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Munver, R., Del Pizzo, J.J. & Sosa, R.E. Adrenal-preserving minimally invasive surgery: The role of laparoscopic partial adrenalectomy, cryosurgery, and radiofrequency ablation of the adrenal gland. Curr Urol Rep 4, 87–92 (2003). https://doi.org/10.1007/s11934-003-0065-4
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DOI: https://doi.org/10.1007/s11934-003-0065-4