title: Laparoscopic adrenalectomy for pheochromocytoma: take the vein last?
abstract: BACKGROUND
  Traditionally, the adrenal vein has been ligated early during excision of a pheochromocytoma. Patient anatomy or size of the lesion can sometimes make early vein dissection difficult or unsafe. This study aimed to demonstrate the safety and efficacy of delayed adrenal vein ligation during laparoscopic adrenalectomy for pheochromocytoma.
  
  
  METHODS
  A retrospective review of all laparoscopic adrenalectomies for pheochromocytoma from 1997 to 2007 was conducted. All the patients had confirmed histologic evidence of pheochromocytoma. The procedures were performed using the same technique, which involved division of the adrenal vein late in the procedure after the gland had been dissected free. Patient records were reviewed for evidence of intraoperative hemodynamic variations, blood loss, length of stay, and postoperative morbidity.
  
  
  RESULTS
  The review examined 27 adrenalectomies performed for 25 patients. Intraoperative hypertension exceeding 170 mmHg was observed in seven patients (26.9%). The overall morbidity was 7.7%, and the mean length of hospital stay was 1.7 days. No deaths occurred.
  
  
  CONCLUSIONS
  Delayed adrenal vein ligation during laparoscopic adrenalectomy for pheochromocytoma is safe and effective. The intraoperative hemodynamic parameters are comparable with those reported in the literature for the "vein first" technique. Dividing the vein late is an alternative approach to laparoscopic excision of adrenal pheochromocytoma and should be considered in appropriate situations.
authors.affiliation: Department of General Surgery, Division of Laparoscopic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. melinavassiliou@gmail.com
authors.forename: Melina C
authors.initials: MC
authors.lastname: Vassiliou
authors.forename: William S
authors.initials: WS
authors.lastname: Laycock
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000311:Adrenal Glands / Q000098:blood supply*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014680:Veins / Q000601:surgery*; D055815:Young Adult