Surgical technique and haemodynamic changes in adrenalectomy for secreting neoplasia. Personal experience and review of the literature.
BACKGROUND
Laparoscopic adrenalectomy is now used worlwide and is a great advance in laparoscopic technology. The reported benefits of this approach include decreased blood loss, better intraoperative haemodynamic control and shorter hospital stay, however some doubts on its indication for adrenal secreting tumors are still present. The aim of this retrospective study is to compare the physiologic alterations on blood pressure during laparoscopic and laparotomic adrenalectomy in patients with adrenal secreting adenoma, the intraoperative blood loss and mean hospital stay in the 2 groups of patients. A review of the literature is included.


METHODS
Laparoscopic adrenalectomy was performed in 13 patients (Conn's syndrome with adrenal adenoma in 10, pheochromocytoma in 3). Laparotomy was used for adrenalectomy in 9 patients: 4 with pheochromocytoma and 5 with Conn's adenoma. All the selected patients in the 2 groups had benign adenoma with tumor size less than 6 cm. During surgery the following data were determined: blood pressure before inducing anaesthesia, pressure peaks, episodes of hypertension and of hypotension, blood loss and operating times. The mean hospital stay was also recorded.


RESULTS
No differences were found in the blood-pressure values of the 2 groups of patients. The blood loss was minimal in all but 2 patients. The mean hospital stay was significantly longer in those patients who underwent laparotomy. No significant differences were recorded in the mean operating time.


CONCLUSIONS
The 2 techniques seem to have the same physiological consequences in the cardiovascular system, and the operating times for laparoscopic and laparotomic adrenalectomy are not so different. Laparoscopic adrenalectomy is a safe technique to treat small benign adrenal secreting adenomas.
Gullà
N
N
Department of Surgical Sciences, Policlinico Monteluce, Section of General and Emergency Surgery, University of Perugia, Perugia, Italy.
Patriti
Alberto
A
Fabbri
B
B
Lazzarini
F
F
Fabbri
C
C
Tristaino
B
B
D000236:Adenoma / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods* / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000378:metabolism; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001794:Blood Pressure / Q000187:drug effects; D004837:Epinephrine / Q000378:metabolism; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D010535:Laparoscopy / Q000706:statistics & numerical data; D007813:Laparotomy / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000378:metabolism; D010673:Pheochromocytoma / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D011229:Preanesthetic Medication; D012189:Retrospective Studies; D020535:Video-Assisted Surgery / Q000706:statistics & numerical data
D000450:Aldosterone; D009638:Norepinephrine; D004837:Epinephrine