Skip to main content
SpringerLink
Log in

Laparoscopic adrenal-sparing surgery: personal experience, review on technical aspects

  • Original Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

Partial adrenalectomy is usually performed for the treatment of bilateral pheochromocytomas and in case of sporadic, monolateral tumors, to minimize the risk of adrenal failure, especially in younger patients. Due to the lack of consistent series, many issues such as correct surgical indications and technical aspects still need to be debated. From 2007 to 2010 we performed four unilateral partial adrenalectomies (3 aldosterone-producing adenomas and 1 cortisol-producing adenoma), and three bilateral subtotal adrenalectomies, consisting in total adrenalectomy on one side and partial adrenalectomy on the contralateral gland (3 bilateral pheochromocytomas in MEN IIa). In case of single tumor, partial adrenalectomy was carried out without adrenal vein ligation and the results were similar to total adrenalectomy both in terms of surgical and functional outcome, with normalization of hormone levels and control of hypertension. Operating time and postoperative stay were not significantly different from unilateral total adrenalectomy. In case of bilateral subtotal adrenalectomy our results demonstrate effectiveness in terms of surgical outcome and control of hypertension, but one patient needed steroid replacement therapy due to post-operative adrenocortical failure. Care must be taken when giving indication to adrenal sparing surgery, because this procedure can be technically difficult, and due to the risk of recurrence, especially in case of bilateral tumors, it can affect both surgical and functional outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Irvin GL, Fishman LM, Sher JA (1983) Familial pheochromocytoma. Surgery 94:938–940

    PubMed  Google Scholar 

  2. Walz MK, Reitgen K, Hoermann R (1996) Posterior retroperitoneoscopy as a new minimally invasive approach for adrenalectomy: results in 37 patients. World J Surg 20:769–774

    Article  PubMed  CAS  Google Scholar 

  3. Neumann HPH, Reincke M, Bender BU, Elsner R, Janetschek G (1999) Preserved adrenocortical function after laparoscopic bilateral adrenal sparing surgery for hereditary pheochromocytoma. J Clin Endocrinol Metabol 84:2608–2610

    Article  CAS  Google Scholar 

  4. Henniford BT, Ianniti DA, Hale J, Gagner M (1997) The role of intraoperative ultrasonography during laparoscopic adrenalectomy. Surgery 122:1068–1073

    Article  Google Scholar 

  5. Imai T, Tanaka Y, Kikumori T et al (1999) Laparoscopic partial adrenalectomy. Surg Endosc 13:343–345

    Article  PubMed  CAS  Google Scholar 

  6. Ikeda Y, Takami H, Niimi M, Saaki Y, Takayama J et al (2001) Laparoscopic partial or cortical sparing adrenalectomy by division of the central adrenal vein. Surg Endosc 15:747–750

    Article  PubMed  CAS  Google Scholar 

  7. Roukounakis N, Dimas S, Kafetzis I, Bethanis S, Gatsulis N, Kostas H, Kyriakou V, Michas S (2007) Is preservation of the adrenal vein mandatory in laparoscopic adrenal-sparing surgery? JSLS 11:215–218

    PubMed  CAS  Google Scholar 

  8. Ihara M, Suzuki R, Kawamata A, Omi Y, Kodama H, Igari Y, Yamazaki K, Obara T (2003) Adrenal-preserving laparoscopic surgery in selected patients with bilateral adrenal tumors. Surgery 134:1066–1073

    Article  Google Scholar 

  9. Van Heerden JA, Sizemore GW, Carney JA, Brennan MD, Sheps SG (1985) Bilateral subtotal adrenal resection for bilateral pheochromocytomas in multiple endocrine neoplasia type IIa: a case report. Surgery 98:363–366

    PubMed  Google Scholar 

  10. Hamberger B, Telenius-Berg M, Cedermark B, grondal S, Hasson BG, Werner S et al (1987) Subtotal adrenalectomy in multiple endocrine neoplasia type 2. Henry Ford Hosp Med J 35:127–128

    PubMed  CAS  Google Scholar 

  11. Lee JE, Curley SA, Gagel RF, Evans DB, hicky RC (1996) Cortical-sparing adrenalectomy for patients with bilateral pheochromocytoma. Surgery 120:1064–1071

    Article  PubMed  CAS  Google Scholar 

  12. Baghai M, Thompson GB, Young WFJ, Grant CS, Michels VV, van Heerden JA (2002) Pheochromocytoma and paragangliomas in von Hippel-Lindau disease: a role for laparoscopic and cortical-sparing surgery. Arch Surg 137:682–689

    Article  PubMed  Google Scholar 

  13. Liao CH, chung SD, Lai MK, Yu HJ, Chueh SC et al (2009) Laparoscopic simultaneous bilateral partial and total adrenalectomy: a longer follow-up. BJU Int 104:1269–1273

    Article  PubMed  Google Scholar 

  14. Diner EK, Franks ME, Behari A, Linehan WM, Walther MM (2005) Partial adrenalectomy: the national cancer institute experience. Urology 66:19–23

    Article  PubMed  Google Scholar 

  15. Kaye DR, Storey BB, Pacak K, Pinto PA, Linehan WM, Bratslavsky G (2010) Partial adrenalectomy: underused first line therapy for small adrenal tumors. J Urol 184:18–25

    Article  PubMed  Google Scholar 

  16. Benhammou JN, Boris RS, Pacak K, Pinto PA, Lineham WM, Bratslavsky G (2010) Functional and oncologic outcomes of partial adrenalectomy for pheochromocytoma in patients with von Hippel-Lindau syndrome after at least 5 years of follow-up. J Urol 184:1855–1859

    Article  PubMed  Google Scholar 

  17. Assalia A, Gagner M (2004) Laparoscopic adrenalectomy. Br J Surg 91:1259–1274

    Article  PubMed  CAS  Google Scholar 

  18. Lezoche E, Guerrieri M, Crosta F, Lezoche G, Baldarelli M, Campagnacci R (2008) Flank approach versus anterior sub-mesocolic access in left laparoscopic adrenalectomy: a prospective randomized study. Surg Endosc 22:2373–2378

    Article  PubMed  CAS  Google Scholar 

  19. Lombardi CP, Raffaelli M, De Crea C, Sollazzi L, Perilli V, Cazzato MT, Bellantone R (2008) Endoscopic adrenalectomy: is there an optimal operative approach? Results of a single-center case–control study. Surgery 144:1008–1014

    Article  PubMed  Google Scholar 

  20. Wang XJ, Shen ZJ, Zhu Y, Zhang RM, Shunk FK, Shao Y, rui WB, He W et al (2010) Retroperitoneoscopic partila adrenalectomy for small adrenal tumors: the Ruijin clinical experience in 88 patients. BJU Int 105:849–853

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that this paper is not under consideration for other journals, there is not conflict of interest regarding this paper, and there is no financial support.

Author information

Authors and Affiliations

  1. Department of Surgery “P. Valdoni”, “Sapienza” University, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy

    Giuseppe Cavallaro, Andrea Polistena & Giorgio De Toma

  2. Department of Clinical Sciences, “Sapienza” University, Policlinico Umberto I, Rome, Italy

    Claudio Letizia

Authors
  1. Giuseppe Cavallaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Claudio Letizia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrea Polistena
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giorgio De Toma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giuseppe Cavallaro.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cavallaro, G., Letizia, C., Polistena, A. et al. Laparoscopic adrenal-sparing surgery: personal experience, review on technical aspects. Updates Surg 63, 35–38 (2011). https://doi.org/10.1007/s13304-011-0052-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-011-0052-0

Keywords

Search

Navigation