The risks of retroperitoneoscopic adrenalectomy
Authors:
P. Zonča; M. Peteja; P. Vávra; V. Richter; P. Ostruszka
Authors‘ workplace:
Chirurgická klinika, FN LF Ostravské univerzity
přednosta: doc. MUDr. P. Zonča, Ph. D., FRCS, MBA
Published in:
Rozhl. Chir., 2017, roč. 96, č. 3, s. 130-133.
Category:
Case Report
Overview
Introduction:
Minimally invasive adrenalectomy has become the gold standard for surgery of the suprarenal gland. Retroperitoneoscopic adrenalectomy with dorsal approach is preferred. The aim of our case report is to discuss potential complications that may arise from retroperitoneoscopic adrenalectomy, specifically an intra-operative injury of the inferior vena cava.
Case report:
A 47-year-old male patient was admitted to undergo elective adrenalectomy on the right side. The reason for the surgery was a hormonally active adenoma with clinical signs of Conn’s syndrome. Biochemistry revealed the typical signs of hyperaldosteronism. A one-year history of unsuccessful treatment for hypertension was known. Ultrasound examination showed an enlarged suprarenal gland on the right side with the diameter of 5.2 cm. A CT scan confirmed the results of the ultrasound examination. Retroperitoneoscopic adrenalectomy was performed. The inferior vena cava was intraoperatively injured. The high pressure in the retroperitoneal space prevented bleeding. The injury to the vena cava was treated using a continuous stitch without the necessity of conversion to open surgery. The patient was discharged on the third postoperative day without any other complications.
Conclusions:
Retroperitoneoscopic approach is regarded by many authors as the new gold standard for adrenalectomy. However, very serious complications such as an injury of the inferior vena cava may occur. It is possible to treat this injury using retroperitoneoscopy. The risk of air embolization due to elevated pressure in the retroperitoneum (20 mm Hg) and open lumen of the IVC needs to be taken seriously.
Key words:
adrenalectomy – retroperitoneoscopy – complication
Sources
1. Snow LL. Endoscopic general surgery: an update. Laser Highlights 1991;2:1–3.
2. Mandressi A, Buizza C, Antonelli D, et al. Retroperitoneoscopy. Ann Urol 1995;29:91–6.
3. Procházka V, Kala Z, Jíra M, et al. [Laparoscopic adrenalectomy--indications and selection criteria.] Czech, Rozhl Chir. 2012;91:230−4.
4. Kasalický M, Krsek M, Zelinka T, et al. [120 laparoscopic adrenalectomies with a harmonic scalpel.] Czech. Rozhl Chir 2009;88:439−43.
5. Zonca P, Cambal M, Labas P, et al. [Retroperitoneoscopic adrenalectomy with dorsal approach.] Czech, Rozhl Chir 2012;91:235−40.
6. Walz MK, Peitgen K, Krause U, et al. Dorsal retroperitoneoscopic adrenalectomy − a new surgical technique. Zentralbl Chir 1995;120:53−8.
7. NCCN Clinical Practice Guidelines in oncology (NCCN Guidelines), Neuroendocrine Tumors, Version 2.2016, availabel from: https://www.nccn.org/professionals/physician_gls/pdf/neuroendocrine.pdf
8. Zonca P, Buzga M, Ihnat P, et al. Retroperitoneoscopic adrenalectomy in obese patients: Is it suitable? Obes Surg 2015; 25:1203–8.
9. Walz MK, Peitgen K, Krause U, et al. Die dorsale Adrenalektomie – eine operative Technik, Zentralbl Chir 1995:53–8.
10. Walz MK, Peitgen K, Walz MV, et al. Posterior retroperitoneoscopic adrenalectomy: lessons learned within five years. World J Surg 2001;25:728–34.
11. Feng Z, Feng MP, Levine JW, Solórzano CC. Robotic retroperitoneoscopic adrenalectomy: useful modifications of the described posterior approach. J Robot Surg 2017 [Epub ahead of print]
12. Walz MK, Alesina PF. Single access retroperitoneoscopic adrenalectomy (SARA)--one step beyond in endocrine surgery. Langenbecks Arch Surg. 2009;394:447–50.
13. Corcione F, Esposito C, Cuccurullo D, et al. Vena cava injury. A serious complication during laparoscopic right adrenalectomy. Surg Endosc 2001;15:218.
14. Mutter D, Wheeler MH, Marescaux J. Laparoscopic management of operative vena cava injury. Surg Laparosc Endosc Percutan Tech 1999;9:303−5.
15. Sho S, Yeh MW, Li N, Livhits MJ. Single-incision retroperitoneoscopic adrenalectomy: a North American experience. Surg Endosc 2016; [Epub ahead of print]
16. Walz MK. Minimally invasive adrenal gland surgery. Transperitoneal or retroperitoneal approach? Chirurg 2012;83:536-45.
17. van Uitert A, d’Ancona FC, Deinum J, et al. Evaluating the learning curve for retroperitoneoscopic adrenalectomy in a high-volume center for laparoscopic adrenal surgery. Surg Endosc. 2016. [Epub ahead of print]
18. Wevers KP, Kist JW, Borel Rinkes IH, et al. Laparoscopic anterior versus endoscopic posterior approach for adrenalectomy: a shift to a new golden standard? Langenbecks Arch Surg 2016; available from: http://link.springer.com/article/10.1007/s00423-016-1533-x
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Surgery Orthopaedics Trauma surgeryArticle was published in
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