Minimal invasive (endoskopische) Adrenalektomie View Full Text


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Article Info

DATE

1999-05-01

AUTHORS

G. Prager, C. Scheuba, C. Passler, Gertraud Heinz-Peer, H. Vierhapper, B. Niederle

ABSTRACT

Background: 7 years after the first successful endoscopic adrenalectomy this new technique is already the „Golden Standard” in adrenal surgery, if the tumor is less than 6 cm in diameter without indirect signs of malignancy.Methods: In a review of the literature (only centres with more than 20 patients were included) and in a preliminary evaluation of 47 own patients the importance of this new technique was analyzed.Results: As in open adrenalectomy different ways to the adrenals developed: using a transperitoneal route (patients in a supine or lateral decubitus position) 786 patients, using a retroperitoneal approach (patients in prone or lateral decubitus position) 223 patients were treated respectively. Independent of the surgical route the conversion rate was 5%. Bleeding and lack of surgical progress were the main reasons for conversion. In 3 out of 47 own patients a conversion from endoscopic to open surgery had to be performed (bleeding 2, tumor adhesion 1). In 39.2% Conn adenomas were the indications for surgery followed by pheocromocytomas (18.8%), benign adrenocortical adenomas (17.6%) and Cushing-syndrome (15.5%).Conclusions: A careful preoperative evaluation and preparation of the patients in a centre with great experience in conventional, open adrenalectomy and an operation frequency of at least 20 patients a year guarantee optimal results of endoscopic adrenalectomy. In experienced hands the surgical approach has no influence on the conversion rate. More... »

PAGES

159-166

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  • 1998-12. Retroperitoneal Adrenalectomy: Open or Endoscopic? in WORLD JOURNAL OF SURGERY
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    33 schema:description Background: 7 years after the first successful endoscopic adrenalectomy this new technique is already the „Golden Standard” in adrenal surgery, if the tumor is less than 6 cm in diameter without indirect signs of malignancy.Methods: In a review of the literature (only centres with more than 20 patients were included) and in a preliminary evaluation of 47 own patients the importance of this new technique was analyzed.Results: As in open adrenalectomy different ways to the adrenals developed: using a transperitoneal route (patients in a supine or lateral decubitus position) 786 patients, using a retroperitoneal approach (patients in prone or lateral decubitus position) 223 patients were treated respectively. Independent of the surgical route the conversion rate was 5%. Bleeding and lack of surgical progress were the main reasons for conversion. In 3 out of 47 own patients a conversion from endoscopic to open surgery had to be performed (bleeding 2, tumor adhesion 1). In 39.2% Conn adenomas were the indications for surgery followed by pheocromocytomas (18.8%), benign adrenocortical adenomas (17.6%) and Cushing-syndrome (15.5%).Conclusions: A careful preoperative evaluation and preparation of the patients in a centre with great experience in conventional, open adrenalectomy and an operation frequency of at least 20 patients a year guarantee optimal results of endoscopic adrenalectomy. In experienced hands the surgical approach has no influence on the conversion rate.
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    41 Cushing's syndrome
    42 adenomas
    43 adrenal surgery
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    46 adrenocortical adenoma
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