[Current concepts in minimal invasive endocrine surgery].
During the past ten years, endoscopic adrenalectomy has emerged as the standard of treatment of benign diseases of the adrenal gland. Although no randomised trial exists comparing open with endoscopic adrenalectomy, the endoscopic approach has proven to be safe with lower morbidity and shorter hospital stay compared with open surgery. For parathyroidectomy several different minimal invasive techniques have been described (i.e. fully endoscopic, videoscopic assisted, and focused using mini-incision). Prerequisits for all of these approaches are a positive preoperative localisation of the adenoma, an intraoperative parathormone testing, and the respective surgical experience in the minimal invasive technique. Proponents of the videoendoscopic assisted thyroidectomy mention the enhanced exposure of the surgical field to be beneficial. However, drawbacks of this technique are the fact that a minority of patients qualify for this approach and that the learning curve is quite long for the surgeon. The experience with the laparoscopic approach to endocrine pancreatic tumours is still limited. Good indications are insulinomas that are located anteriorly or within the tail of the pancreatic gland. Nowadays, laparoscopic enucleation of such tumours and tail resections become feasable and safe.
Oertli
D
D
Klinik für Allgemeinchirurgie am Universitätsspital Basel. doertli@uhbs.ch
D000236:Adenoma / Q000175:diagnosis / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods*; D000368:Aged; D004724:Endoscopy; D005260:Female; D006801:Humans; D007340:Insulinoma / Q000601:surgery; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000175:diagnosis / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods*; D018579:Patient Selection; D011183:Postoperative Complications; D012449:Safety; D013965:Thyroidectomy / Q000379:methods*; D013997:Time Factors