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Chun-Hou Liao

Publications and source records attributed to Chun-Hou Liao.

5 recordsLinked to original sources
PubMed2006

Laparoscopic partial adrenalectomy for aldosterone-producing adenomas with needlescopic instruments.

INTRODUCTION: Laparoscopic total adrenalectomy is the treatment of choice for aldosterone-producing adenomas (APAs). There have not been many reports of laparoscopic partial adrenalectomy, although this procedure offers benefits to patients with suspected bilateral APAs or an APA in a solitary adrenal gland. We describe the feasibility of a novel technique of laparoscopic partial adrenalectomy for APA solely using 2-mm working instruments and a 5 to 10-mm telescope. TECHNICAL CONSIDERATIONS: Six unilateral and two bilateral partial adrenalectomies were performed laparoscopically. Only one umbilical 12-mm port for the telescope and two (for left adenomas) or three (for right adenomas) subcostal 2-mm working ports were used. Hemostasis and transection of adrenal tissues were performed using a 2-mm mini-bipolar coagulator and 2-mm scissors. RESULTS: All laparoscopic operations were successfully performed using only 2-mm working instruments and a 5 or 10-mm 30 degree telescope with no intraoperative or postoperative complications. Blood loss was minimal, and the operative times were comparable to those of previous reports. All patients had low pain scores, required minimal amounts of narcotics postoperatively, and reported excellent cosmetic results for the wounds. The pathologic examinations confirmed complete excision of all adenomas with intact capsules. The plasma aldosterone concentrations and renin activities returned to normal ranges postoperatively in all patients. At a mean follow-up of 25 months (range 13 to 48), 7 (87.5%) were cured of their hypertension and 1 had the hypertensive medications significantly reduced. CONCLUSIONS: Laparoscopic partial adrenalectomy for APAs using 2-mm working instruments and a 5 to 10-mm telescope is a safe and effective treatment alternative.

Adenoma↗
PubMed2006

Laparoscopic adrenalectomy for potentially malignant adrenal tumors greater than 5 centimeters.

PURPOSE: Laparoscopic adrenalectomy (LA) is controversial for large, potentially malignant tumors. We report a series of LA or hand-assisted LA for large (>5 cm) adrenal tumors. PATIENTS AND METHODS: Among 210 LAs performed in 6 yr, 39 patients had potentially malignant tumors greater than 5 cm in diameter. Their perioperative and follow-up data were retrospectively analyzed. RESULTS: All 39 patients had successful LAs without perioperative mortality, conversion to open surgery, or capsular disruption during dissection. The mean tumor size was 6.2 cm (range, 5-12 cm), operative time 207 min (115-315 min), and blood loss 75 ml (minimal-1400 ml). Complications included one intraoperative diaphragmatic perforation, three mild wound infections, and one pneumonia. Preoperatively there were 27 nonfunctioning tumors, seven pheochromocytomas, three cortisol-secreting tumors, and two virilizing tumors. Final pathology revealed eight malignant (four adrenocortical carcinomas and four metastatic carcinomas) and 31 benign tumors (14 cortical adenomas, eight pheochromocytomas, six myelolipomas, and three ganglioneuromas). Median follow-up was 39 months. Four patients (two adrenocortical carcinomas, one metastatic hepatoma, and one lymphoma) died 24, 10, 9, and 3 months after surgery, respectively. A hand-assisted device was used in 10 patients. Only the tumor size was larger and length of postoperative hospital stay longer for those in the hand-assisted group. CONCLUSIONS: LA is a reasonable option for selected large adrenal tumors when complete resection is technically feasible and there is no evidence of local invasion. Hand-assisted LA is a good alternative to open conversion if a difficult dissection is encountered intraoperatively.

Adenoma↗
PubMed2002

Clipless laparoscopic adrenalectomy with needlescopic instruments.

PURPOSE: We describe our experience with clipless laparoscopic adrenalectomy using needlescopic instruments. We compared the results with those of a contemporary series of conventional laparoscopic adrenalectomy. MATERIALS AND METHODS: In 12 patients clipless laparoscopic adrenalectomy was performed with needlescopic instruments in an 8-month period. The technique included 2 or 3 subcostal 2 mm. ports and 1 umbilical 5/12 mm. port for the telescope and ultimate specimen extraction. Adrenal vessels were controlled by bipolar coagulation without endoscopic clips. Outcome data were retrospectively compared with those on 20 recent conventional laparoscopic adrenalectomies done at the same institution. The 2 types of laparoscopic adrenalectomy were performed transperitoneally. RESULTS: Patients in the clipless group had a lower mean analgesic requirement (7.5 versus 15.3 mg. morphine sulfate equivalent, p = 0.02), lower mean pain and scar scores (3.1 versus 5.3 and 1.1 versus 4.2, respectively, p <0.05) and more rapid convalescence (1.6 versus 3.3 weeks, p <0.01) but longer operative time (183 versus 136 minutes, p = 0.04). Similar blood loss, time to oral intake and hospital stay were noted in the 2 groups. No major complications, open conversions or postoperative secondary bleeding occurred in either group. A 2 mm. port was converted to a 10 mm. port in only 1 case in the clipless group due to the inability to retract a bulky liver properly with a needlescopic instrument. CONCLUSIONS: Clipless laparoscopic adrenalectomy with needlescopic instruments is feasible for most benign adrenal tumors. In addition to the benefits of conventional laparoscopic surgery, clipless needlescopic laparoscopic adrenalectomy further decreased postoperative pain, shortened convalescence and improved wound cosmesis.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

Clipless needlescopic bilateral varix ligation.

We report a novel technique of clipless needlescopic bilateral varix ligation and compare its results with the conventional laparoscopic approach. The positions of ports and surgical procedures were similar to those of the conventional 3-port laparoscopic technique, but all 5- and 10-mm trocars were replaced by 2-mm trocars. The internal spermatic veins proximal to the internal inguinal ring were isolated and coagulated for an adequate segment with a 2-mm bipolar electrocautery apparatus and then transected. The perioperative parameters of 25 patients operated on in this manner were compared with a historical cohort of 25 patients operated on using the conventional laparoscopic approach. Both groups of patients had uneventful surgery with no complications. The mean amount of analgesics used (1.25 vs 3.68 mg of morphine sulfate equivalent, P=.03), the maximal and mean postoperative pain scores (3.5 vs 5.6 and 2.5 vs 4.0, respectively, both P <.05), the postoperative hospital stay (0.5 vs 1.1 days, P=.03), and convalescence to normal activity (0.56 +/- 0.3 vs 1.64 +/- 0.4 weeks, P=.01) were all significantly decreased in the needlescopic group. We conclude that needlescopic bilateral varix ligation not only is feasible and safe but also provides the same therapeutic efficacy of a conventional laparoscopic approach; most importantly, it causes less pain and yields faster convalescence and excellent cosmetic results.

Adult↗