SEARCH · PubMed Health

Results for “ADRENALECTOMY”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 703 records · Page 39Linked to original sources

PubMed2001

Experience with retroperitoneal laparoscopic adrenalectomy in 115 procedures.

PURPOSE: Laparoscopic adrenalectomy has become an effective option for removing small adrenal tumors. We evaluated the retroperitoneal approach with regard to operative complications, morbidity and hospital stay. MATERIALS AND METHODS: Between January 1995 and March 2000 we performed a total of 115 laparoscopic adrenalectomies via the retroperitoneal approach, including 70 on the left and 45 on the right side, in 64 women and 42 men 17 to 74 years old (mean age 49.3) with adrenal neoplasms. Average adrenal tumor size was 31 mm. (range 10 to 65). All procedures required 4 trocars and mean operative time was 118 minutes (range 45 to 240). RESULTS: There were no patient deaths. The conversion rate to open surgery was 0.8% and estimated blood loss was 77 ml. (range 0 to 550). At a mean followup of 23.4 months, morbidity was 15.5% with intraoperative vascular injury in 3 cases (3.4%) and postoperative complications in 12.1%, including wound infection, deep hematoma, parietal dehiscence and severe pneumopathy. Average hospital stay was 4 days and mean duration of analgesic requirement was 2 days (range 1 to 5). CONCLUSIONS: The retroperitoneal approach to laparoscopic adrenalectomy appears to be minimally invasive and safe for adrenal tumors not larger than 5 cm.

Adolescent↗

PubMed2001

The case for laparoscopic adrenalectomy.

PURPOSE: The current status of laparoscopic adrenal surgery was assessed. MATERIALS AND METHODS: A current MEDLINE search revealed 308 articles pertaining to laparoscopic surgery of the adrenal gland. Based on this literature review laparoscopic surgical anatomy, current indications and contraindications, and laparoscopic techniques were identified. The role of laparoscopic surgery for various adrenal disorders, including aldosteroma, pheochromocytoma, Cushing's syndrome, incidentaloma and adrenal cancer, were evaluated. Studies specifically comparing open versus laparoscopic adrenalectomy and the financial implications of laparoscopy were evaluated. Furthermore, newer advances in the minimally invasive management of surgical adrenal disease were identified. RESULTS: Available data from multiple institutions imply that laparoscopic adrenal surgery is safe and efficacious for aldosteroma, pheochromocytoma, Cushing's disease and incidentaloma. Compared to open surgery laparoscopy provides equally effective treatment, while minimizing patient morbidity. Laparoscopic adrenalectomy is financially superior to open adrenalectomy. For adrenal cancer open surgery currently remains the treatment of choice. CONCLUSIONS: In the majority of patients with surgical adrenal disease except those with adrenal cancer laparoscopy may now be considered an established treatment modality.

Adrenal Gland Neoplasms↗

PubMed2001

Comparison of 3 surgical approaches to laparoscopic adrenalectomy: a nonrandomized, background matched analysis.

PURPOSE: To clarify the characteristics of surgical approaches to laparoscopic adrenalectomy we performed background matched analysis of clinical outcomes of the 3 approaches. MATERIALS AND METHODS: From February 1992 to July 2000 we performed 118 laparoscopic adrenalectomies in 115 patients with adrenal tumors. For these operations we used the anterior transperitoneal approach in 46 patients, the lateral transperitoneal approach in 32 and the lateral retroperitoneal approach in 40. RESULTS: To exclude the learning curve effect we eliminated our initial 20 patients treated with the anterior transperitoneal approach. To allow background matching of the 3 groups we also excluded 14 patients with tumors more than 5 cm., 6 who underwent conversion to open surgery and 1 patient who required 5 days of bed rest for retroperitoneal hematoma caused by bleeding from a trocar port. The final analysis included 16, 25 and 36 cases managed via the anterior transperitoneal, lateral transperitoneal and lateral retroperitoneal approach, respectively. Average operative time was significantly shorter for the lateral transperitoneal approach. Postoperative recovery was not significantly different in the lateral transperitoneal and lateral retroperitoneal groups. Postoperative complications included mild paralytic ileus in 2 patients and shoulder tip pain, probably peritoneal irritation due to carbon dioxide insufflation and bowel preparation, in 4 in the transperitoneal groups. Our results imply that the easiest procedure is the lateral transperitoneal approach but the lateral retroperitoneal approach is slightly less invasive. CONCLUSIONS: Although it is important to remember that this study was not a prospective randomized trial and, thus, had from certain biases, we believe that if a tumor is more than 5 cm. and/or the surgeon is not yet skilled in laparoscopic adrenalectomy, the lateral transperitoneal approach is the most suitable method. If the surgeon has performed at least 20 operations, the adrenal tumor is unilateral and the lesion is less than 5 cm., the lateral retroperitoneal approach seems to be more suitable because of its minimally invasive nature. The lateral retroperitoneal approach is also preferred in patients with a history of upper abdominal surgery. With improvements in technique and new instruments the time required for the lateral retroperitoneal approach has been significantly decreased.

Adrenal Gland Neoplasms↗

PubMed2001

[Retroperitoneal laparoscopic adrenalectomy: a safe and reproducible technique].

INTRODUCTION: Laparoscopic adrenalectomy has become one of the reference techniques for resection of small tumours of the adrenal gland. The objective of this study was to evaluate the retroperitoneal approach in terms of its intraoperative complication rate, morbidity and length of hospital stay, comparing two centres using the same surgical technique. MATERIAL AND METHOD: Between January 1995 and March 2000, two different centres respectively performed 55 and 60 laparoscopic adrenalectomies (70 left, 45 right) using a retroperitoneal incision in 106 patients (64 women and 42 men) with a mean age of 49.3 years (range: 17 to 74 years). The mean size of the adrenal tumour was 31 mm (range: 10 to 61 mm). Five trocars were used in every case. RESULTS: No difference was observed between the two centres in terms of operating time (100 min vs 135 min), conversion rate (0% vs 1.7%), and blood loss (74 ml vs 80 ml). With a mean follow-up of 23.4 months, no difference was observed for morbidity rate (12.7% vs 16.7%), including intraoperative complications (1.8% vs 5%) with 3 vascular injuries, and postoperative complications (10.9% vs 11.7%) comprising wound abscesses, deep haematomas, a hernia at the trocar orifice and one case of severe pneumonia. The mean hospital stay was 3 days vs 5 days with a mean duration of analgesic consumption of 2 days (range: 1 to 5 days). CONCLUSION: Laparoscopic retroperitoneal adrenalectomy appears to be a reliable and reproducible approach for resection of adrenal gland tumours less than 6 cm in diameter.

Adolescent↗

PubMed2001

[Our experience with adrenalectomy (1994-2000). Overall review].

OBJECTIVE: Thirty cases of adrenalectomy are presented. The diagnostic and therapeutic aspects of adrenal disease are reviewed. METHODS: Over the last 6 years, 30 adrenalectomies were performed in 28 patients (20 females and 8 males) aged 16-83 years (mean age 51 years). The lesion was incidentally discovered in 18.5%, 33.3% presented abdominal or lumbar pain, 18.5% had Cushing's syndrome, 18.5% presented headache and hypertension, and 7.4% virilization. Diagnostic evaluation included laboratory studies, ultrasound and CT assessment. Scintigraphic localization with MIBG, MRI or arteriography was performed in specific cases. The flank approach was utilized in 53% of the cases. RESULTS: The postoperative period ranged from 7-23 days (mean 11). Postoperative complications (38.4%) following adrenalectomy were splenectomy, hemorrhage, hypertensive episodes, vascular complications, wound infection and pneumonia. Fifty percent of the masses were pheochromocytomas, 10% carcinomas and 5% adenomas. The rest were two neural crest derived tumors, one calcified cyst, one myelolipoma and one metastatic renal carcinoma. CONCLUSION: The diagnostic and therapeutic aspects of adrenal disease are reviewed.

Adolescent↗

PubMed2001

Effect of adrenalectomy and hydrocortisone on ventral prostate of rats.

AIM: To study the effects of adrenalectomy and hydrocortisone on the ventral prostate of SD rats. METHODS: In adrenalectomised (ADX) and ADX + hydrocortisone (1, 2, or 4 mg) treated rats, the prostatic histology and the cholesterol, protein, zinc, and copper levels and the enzymic profile (acid phosphatase, alkaline phosphatase, aryl sulphatase, lactic dehydrogenase, and leucine aminopeptidase) in the prostatic tissue were determined; the serum hormonal profile (testosterone, FSH and LH) was also assayed. RESULTS: Adrenalectomy caused a progressive degeneration in prostatic structure that was not reversed by hydrocortisone treatment. The serum testosterone were significantly lower in ADX than in sham operated rats and lower in ADX + hydrocortisone than in ADX-C rats (P < 0. 01). The serum FSH and LH were below the detection limit of 1 mIU/mL. The enzymatic activity was higher in ADX than in sham operated rats and higher in ADX + hydrocortisone than in ADX-C rats (P < 0.05-0.01). The prostatic zinc levels were significantly higher in sham operated than in ADX, and higher in ADX-C than in ADX + hydrocortisone rats (P < 0.05-0.01). The prostatic copper level was significantly lower in sham operated than in ADX, and lower in ADX-C than in the ADX + hydrocortisone rats (P < 0.01). CONCLUSION: In rats, adrenalectomy leads to pathological and functional changes of the prostate. Hydrocortisone treatment at the doses employed did not reverse these changes.

Adrenalectomy↗

PubMed2002

[Laparoscopic transperitoneal adrenalectomy in hormonally-active adrenal tumors].

Laparoscopic adrenalectomy is considered the "gold standard" in adrenal surgery for benign functioning (and non-functioning) tumors. Laparoscopy meets criteria of miniinvasive surgery with minimal postoperative pain, short hospital stay and an outstanding cosmetic effect, the radicality of the procedure, open surgery and laparoscopy are equally effective. In cooperation with endocrinological department focused on detection of functioning adrenal tumors, the diagnostic and therapeutic procedure seems to be very efficient, so that the primary goal of rapid cure could be achieved. Patients after laparoscopic adrenalectomy mostly do not need chronic antihypertensive medication and only those after bilateral adrenalectomy (Cushing's disease) require life-long low dose hydrocortisone therapy. In pheochromocytomas, total excision of the tumor is considered to be a life-saving procedure, although up to 20% may recur as hereditary or as a part of von Hippel-Lindau's disease.

Adrenal Cortex Hormones↗

PubMed2001

[Open versus video-endoscopic approach in the treatment of hypercortisolism by bilateral adrenalectomy].

Progress in the technique of the hypophysectomy and in the imaging procedures reduced drastically the indications of bilateral adrenalectomy (BA) in the treatment of hypercortisolism (HC). Indeed BA is indicated in 10 to 30% after failure of pituitary surgery, when HC is related to ACTH ectopic secretion, and in HC related to autonomous adrenal secretion. The purpose of this work is to demonstrate the validity of the bilateral video endoscopic adrenalectomy (BVA) in regard to open surgery. During the last 20 years, 88 patients were operated on by open adrenalectomy (Group 1), either by transperitoneal approach, or bilateral posterior lombetomy. From 1994, 62 patients (Group 2), were operated by video endoscopy. Two death occurred in group 1. The frequency of the preoperative complications were identical in each group, but postoperative morbidity were lower in the group 2. The fall in the postoperative pain, the simplicity of the follow up, the rapid hospital discharge, the low rate of parietal complications were observed in BVA. We conclude that the postoperative follow up is better after BVA a specialized training and time of adaptation are imposed to the surgeon.

Adrenalectomy↗

PubMedDate not supplied

[Laparoscopic adrenalectomy].

OBJECTIVES: To review indications, techniques and results of laparoscopic adrenalectomy. METHODS: We retrospectively review our experience with 8 cases of transperitoneal laparoscopic adrenalectomy (2 pheochromocytomas, 4 aldosteromas, 1 myelolipoma and 1 non functioning adenoma). RESULTS: Mean operative time was about 3 hours, with an mean estimated blood loss of 200 cc. Mean Hospital stay was 2.5 days, complication rate was 10%, being conversion to open surgery between 5 and 10%. CONCLUSIONS: Laparoscopic adrenalectomy is the operation of choice for functioning adrenal tumours and for incidentally diagnosed tumours < or = 6 cm that have increased in size in successive radiographic examinations.

Adenoma↗

PubMed2002

A new technique for laparoscopic left adrenalectomy.

After the first description of laparoscopic adrenalectomy was published in 1992, this method rapidly attracted widespread interest. Similar to conventional open techniques two main approaches have ben established for the minimally invasive adrenalectomy: the transabdominal and the retroperitoneal. With the transabdominal technique several different routes for exploration of the glands are possible as the patient can be operated on in a lateral, semi-lateral, or even in a supine position for both glands. Determining the best approach for the left side is further complicated because of the many possible techniques for exploration: through the gastrolienal, gastrocolic, or splenophrenic ligaments. The authors have developed a new method for the left laparoscopic adrenalectomy using the splenophrenic approach.

Adrenalectomy↗

PubMedDate not supplied

[Gas-free lateral retroperitoneoscopy from an open mini-approach for adrenalectomy].

The aim of the study was assessment of efficacy of gas-free lateral retroperitoneoscopy from the open mini-approach for adrenalectomy. Arguments are given for location of the mini-cut in the anterior segment of the 10th intercostal space and analysis was made of operative space parameters in retroperitoneoscopy from open mini-approach. The wound aperture 5.0 cm in size and 15.0 cm in depth is good as it provides the diameter of the monofocal zone 16.0 cm and bifocal zone 4.0 cm. If the size of the wound increases to 7.0 cm, the above parameters rise to 20.0 and 7.9 cm, respectively. Such visualized space is sufficient for adrenalectomy. Variants of the intervention are proposed depending on the side and kind of the lesion. A total of 21 patients with various adrenal pathology were operated. The operation lasted for 114.7 +/- 1.5 min. Overall blood loss reached 22.0 +/- 3.2 ml, transfusion--137.8 +/- 1.0 ml. The intestinal function normalized on day 1-2. In the postoperative period mean number of narcotic analgetics injections made up 4.9 +/- 1.5. Body temperature returned to normal on day 5.3 +/- 1.6 after the intervention. The length of the scar was 4.2 +/- 0.6 cm. None lethal cases were registered. Conversion to the classic open procedure had to be made in four cases. Gas-free lateral retroperitoneoscopic adrenalectomy from open mini-approach is minimally invasive operation. In well selected cases this is a safe and effective alternative to conventional and endovideoscopic gas surgery.

Adolescent↗

PubMedDate not supplied

Current indications for laparoscopic adrenalectomy in the era of minimally invasive surgery.

The aim of this study was to clarify the current indications for laparoscopic adrenalectomy, reviewing both our own experience and the literature data. Since January 2000, 22 patients have undergone adrenalectomy in our department: 17 (77.3%) with the laparoscopic approach and 5 (22.7%) with the traditional one. The indications for laparoscopy were: 6 Cushing's adenomas, 4 aldosterone-producing adenomas, 4 non-functional adenomas, 2 pituitary-dependent bilateral adrenocortical hyperplasias and 1 metachronous adrenal metastasis. The conversion rate to laparotomy was 11.7%. The indications for the open approach were: tumours greater than 7 cm and previous abdominal surgery. The mean size of laparoscopic specimens was smaller than those removed by the open procedure (3.9 cm versus 6.7 cm). The mean postoperative hospital stay in the laparoscopic group was 4.9 days as compared to 10.2 days in the open group. Morbidity was encountered in 2/17 laparoscopically treated patients (11.7%) and in 2/5 patients in the open group. In our early experience, laparoscopic adrenalectomy has been the procedure of choice for removing unilateral or bilateral tumours measuring less than 7 cm in diameter. Nevertheless, apart from diameter cut-off, on the basis of evidence from the literature, an invasive carcinoma is currently considered the only absolute contraindication to laparoscopy.

Adenoma↗

PubMedDate not supplied

Outcome of patients undergoing laparoscopic adrenalectomy for primary hyperaldosteronism.

OBJECTIVES: To study the long-term outcome of patients with primary hyperaldosteronism who underwent laparoscopic adrenalectomy and to determine the preoperative predictive factors of persistent hypertension. METHODS: Between 1996 and 2002, 47 patients with primary hyperaldosteronism underwent transperitoneal laparoscopic adrenalectomy at our institution. Their clinical and biochemical parameters were reviewed retrospectively, and the outcome of 46 patients with complete follow-up notes were determined. RESULTS: The study comprised 16 male and 30 female patients with a mean age of 45.6 years (range, 18 to 63 years). Almost all patients had hypertension and hypokalemia at presentation, requiring medication. The average operating time was 127 minutes (range, 70 to 240 min), and the mean postoperative stay was 2.6 days (range, 1 to 5 days). No mortalities occurred, and perioperative morbidity was minimal. Forty-two (91%) patients had adrenal cortical adenoma (including 1 with both adenoma and hyperplasia), and 4 (9%) had adrenal hyperplasia on histology. The average follow-up time was 21 months (range, 1 to 60 months), and at the end of follow-up, all patients had normal serum potassium levels without potassium supplements. Twenty-three (50%) patients were cured of hypertension, and 13 (28%) patients had better control of their hypertension as evidenced by the decrease in the number of antihypertensive medications used. On multivariate analysis, the age of the patient at surgery was shown to be an independent predictive factor of persistent hypertension after successful surgery. CONCLUSION: Laparoscopic adrenalectomy is a safe and effective way to treat primary hyperaldosteronism, especially in controlling hypokalemia and in the management of hypertension. The age of a patient at surgery is an independent preoperative risk factor of persistent hypertension.

Adolescent↗

PubMed2005

[Hand-assisted laparoscopic adrenalectomy to a solitary adrenal metastasis from lung cancer].

A 75-year-old man with right chest pain was diagnosed with primary lung cancer in the right apical portion, and was treated with chemoradiotherapy because of a synchronous left adrenal tumor of 1.6 cm. Since the adrenal tumor did not increase in size for three months and there were no other relapses, the right upper lobectomy of the lung with the excision of the chest wall was performed. Afterward, an enlargement of the left adrenal tumor was encountered; he was admitted to our hospital for an operation. For the metastatic adrenal tumor from lung cancer, we performed a hand-assisted laparoscopic adrenalectomy. He recovered rapidly and returned to the previous hospital in two weeks after the operation. After the first report in 1992, the laparoscopic adrenalectomy has been established as the curative operation to adrenal benign tumor. The indication is being expanded to the malignancy because of the improvement of operation techniques and advancement of the operation equipments. We conclude that the laparoscopic adrenalectomy for malignant tumor is a safe, curative, and clinically useful surgical technique.

Adrenal Gland Neoplasms↗

PubMedDate not supplied

[Binding ability of rat transcortin after adrenalectomy].

High performance liquid chromatography was used to determine corticosterone concentration and transcortin binding capacity (TBC) in blood plasma of rats with bilateral adrenalectomy, before and after removal of endogenous hormones within 7 days (0.4, 0.2, 1, 2, 3, 4, 5, 7 days). During the first day TBC significantly decreased. However, concentration of protein binding sites subsequently elevated exceeding 2-fold the level of control values within the 7th day of the experiment. Concentration of 14C-immunoreactive transcortin in rat liver cytosol did not differ from control levels on the 5th day after the adrenalectomy. The adrenalectomy did not affect the transcortin affinity constant for corticosterone. These data suggest that the increased rate of blood plasma TBC was not related to activation of liver specific protein biosynthesis.

Adrenal Glands↗

PubMed2006

[Transperitoneal laparoscopic adrenalectomy: initial experience].

OBJECTIVES: Since the first published report in 1992, laparoscopic adrenalectomy has been widespread and it is now accepted as the standard treatment option in most of benign diseases of the adrenal gland. Aim of the present study is to describe our initial experience with laparoscopic adrenalectomy. METHODS: Between May 2001 and December 2005, 15 patients were submitted to laparoscopic adrenalectomy for benign diseases of the adrenal gland. We analyzed patients characteristics (sex, age, initial diagnosis), operative and perioperative results (operative time, blood loss, time to first oral intake) and complications. RESULTS: Mean operative time was 143 minutes. Blood loss was minimal. Mean hospital stay was 90 hours. There was no need for open conversion and complication rate was low. CONCLUSIONS: Laparoscopic surgery of the adrenal gland is a safe and effective option which offers quality of life benefits to the patients.

Adrenal Gland Diseases↗

PubMedDate not supplied

Electron microscopic findings in rat hypophysis after adrenalectomy and administration of ACTH. I. Adenohypophysis.

Ultrastructural changes in the secretory lobe of rat hypophysis following bilateral adrenalectomy and a single subcutaneous administration of 1 i.u. of ACTH were studied. Both after adrenalectomy and ACTH administration, ultrastructural changes were found to appear exclusively in one type of secretory cells. After adrenalectomy, pictures were found in these cells indicative of increased synthesis of the secretory granulations. One hour after the administration of ACTH the ACTH-secreting cells showed features of decreased secretory activity.

Adrenalectomy↗

PubMedDate not supplied

Electron microscopic findings in rat hypophysis after adrenalectomy and administration of ACTH. II. Neurohypophysis.

Electron-microscopic changes in the neural lobe of the rat hypophysis following adrenalectomy and a single administration of ACTH were studied. Twelve hours after adrenalectomy, a decrease in the amount of neurosecretory substances was observed, manifested by a small number of elementary granules of high electron density and, by the appearance of a great number of optically empty vesicles and masses of membrane-free material of low electron density. The increased secretion of neurosecretory substances after adrenalectomy seems to be related to the increased requirement of the organism for the ACTH-releasing factor. One hour after administration of ACTH, a picture was observed suggestive of the release of neurosecretory substances from the neural lobe fibers, which is probably connected with disturbances in the composition of blood electrolytes accompanying the excess of adrenocortical hormones.

Adrenalectomy↗