Surgical technique: Retroperitoneoscopic approach for adrenal masses in children.
Laparoscopic adrenalectomy is considered to be the standard of care for the surgical excision of adrenal masses. The transperitoneal laparoscopic and retroperitoneoscopic approaches are described. Both are safe and as effective as open adrenalectomy, with the added benefit of the minimally invasive approach. It can be utilized for patients requiring surgery for a phaeochromocytoma, adrenal adenoma, adrenal adenocarcinoma, Cushing's syndrome, neuroblastoma, and an incidentaloma. Relative contraindications include previous surgery of the liver or kidney, large tumours (>8-10 cm in diameter) or coagulation disorders. Although the transperitoneal route is used more widely, the retroperitoneal approach provides direct access to the adrenal gland and easy visualization of the adrenal vein. It avoids also colonic mobilization, minimizes the risk of injury to hollow viscera, and the potential risk of adhesion formation. However, the reversed orientation of the kidney and hilum, combined with a significantly smaller working space, may make this approach difficult to master.
Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 1EH, UK.
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Yankovic
Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 1EH, UK.
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Undre
Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 1EH, UK. Electronic address: Imran.mushtaq@gosh.nhs.uk.
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Mushtaq
D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D056888:Patient Positioning; D061214:Patient Safety; D012187:Retroperitoneal Space / Q000601:surgery
Adrenal masses; Laparoscopic adrenalectomy; Minimally invasive surgery; Paediatric adrenalectomy; Retroperitoneoscopic adrenalectomy