Minimal invasive chirurgische Endokrinologie View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2000-11

AUTHORS

B. Niederle, G. Prager, C. Scheuba, C. Passler, M. Schindl

ABSTRACT

Background: Following the first successful endoscopic adrenalectomy in 1992 minimally invasive surgical techniques have been introduced to endocrine surgery.Methods: The current minimally invasive techniques in the treatment of adrenal, parathyroid, thyroid and neuro-endocrine gastrointestinal tumours are reviewed.Results: Adrenal tumours can be removed endoscopically through a transperitoneal (patient in a supine or lateral decubitus position) or through an extraperitoneal rout (patient in a lateral Decubitus or prone position). The most popular is the endoscopic transperitoneal adrenalectomy: 1151 patients are documented in literature. 58 patients (5 %) had to be converted to an open procedure. 348 tumours were removed by an extraperitoneal access. The conversion rate was 5.7 % (20 patients). The basis of excellent results is a careful evaluation and preparation of the patient in a centre with experience in the open techniques and a frequency of at least 20 endoscopic adrenalectomies a year. In experienced hands there is no difference in the postoperative results using different accesses.Cosmetics was the argument to introduce minimally invasive procedures in thyroid and parathyroid surgery.The endoscopic exploration of the parathyroids in patients with biochemically proven primary hyperparathyroidism (described in 15 patients) was modified to video-assisted exploration (about 300 patients documented in literature) because of the long operating times (140 to 300 minutes) and the drawbacks of skin emphysema and hyperkapnia. The basis for both are: localised single gland disease, initial exploration, adenomas not larger than 30 mm, no concomitant thyroid disease and experience with the quick PTH assay. An alternative to the video-assisted procedure is the minimally invasive „open“ exploration (up to now about 500 patients documented). A paramedian incision (20 mm) and a lateral access to the thyroid and parathyroids is used. Using this technique the recurrent nerve can be explored safely. Also re-operations can be performed and adenomas >30 mm in diameter and ipsilateral thyroid nodules (found in more than 50 % in middle Europe) can be removed. A conversion to the bilateral exploration (causes: false positive localisation; unexpected multiple gland disease, difficult preparation) was necessary in 14% to 23%. In special patients an ectopic parathyroid adenoma can be removed thoracoscopically.Small solitary thyroid nodules were the indication for an endoscopic exploration of the thyroid in 50 patients (perating time: 315 minutes). In about 30 patients a hemithyroidectomy was performed (up to 147 minutes). Because of bleeding, adhesions or unexpected thyroid cancer in 7% to 33% the endoscopic procedure had to be converted to open surgery.A laparoscopic exploration of the pancreas was performed in 34 patients with neuro-endocrine tumours (insulinoma: 29; gastrinoma: 2, unclassified: 3). The endocrine turnours were enucleated or removed by distal pancreatic resection successfully in 12 out of 17 and in 13 out of 17 patients respectively.Conclusions: The endoscopic adrenalectomy is the new „Golden Standard“ in the treatment of benign adrenal tumours up to 6 cm. Endoscopic, video-assisted or minimally invasive open parathyroidectomy is not established yet. Endoscopic explorations of the thyroid and the endocrine pancreas are supposed to be still experimental. More... »

PAGES

39

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/bf02950234

DOI

http://dx.doi.org/10.1007/bf02950234

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https://app.dimensions.ai/details/publication/pub.1005458645


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