جستجوی مقالات مرتبط با کلیدواژه "adrenalectomy" در نشریات گروه "پزشکی"

Partial adrenalectomy (PA) is an emerging modality typically performed for the treatment of hereditary and sporadic bilateral tumors, to reduce the risk of adrenal failure. In this study, we evaluated the recurrence and functional outcomes after partial and total adrenalectomy (TA).

From March 2005 to July 2018, 284 patients with functional tumor or > 5 cm adrenal mass underwent clipless and sutureless laparoscopic partial or total adrenalectomy (PLA and TLA). Patients with a pathological diagnosis of pheochromocytoma, Cushing or Conn’s disease and more than two year follow up were included in this study. Pre-operative and operative variables were collected retrospectively and functional outcomes and recurrence were gathered prospectively.

One hundred forty patients (mean age: 43±5.1years) were included in the study. PLA and TLA were per-formed for pheochromocytoma (total n=78; PLA=12 (15%), TLA=66 (85%)), Cushing syndrome (toal n=17; PLA = 4 (24%), TLA = 13 (76%)), and Conn’s disease (total n=45; PLA=7 (16%), TLA=38 (84%)). In pheochromo-cytoma patients, improvement of hypertension, palpitation, and headache was not different between patients who underwent PLA versus TLA (all P > 0.05). Two recurrences were observed in patients with pheochromocytoma who had undergone TLA. In patients with Cushing disease, central obesity, fascial plethora, and hypertension were improved in all patients six months after treatment, muscle weakness was improved one year after surgery, and acne and hyperpigmentation only improved two years after surgery. The length of time for resolution of symptoms was not different in patients who underwent PLA versus TLA. In Conn’s disease hypertension was resolved in all patients and no patient required potassium supplements post-operatively. In follow up no recurrence was observed in patients with a pathological diagnosis of Cushing or Conn’s disease.

In our experience, PLA can provide excellent control of the symptoms parallel with TLA and with no statistically significant difference in recurrence making PLA an attractive option in patients with an adrenal mass.

Laparoscopy surgery is the gold standard for the treatment of aldosterone-producing adenomas (APA). However, the effectiveness between laparoscopic total and partial adrenalectomy is controversial. Therefore, we retrospectively analyzed the postoperative and follow-up outcomes of these two procedures.

A total of 96 APA patients underwent laparoscopic surgery in our hospital between Jan - uary 2012 and December 2017. A total of 65 patients who underwent laparoscopic partial adrenalectomy (group 1) were compared with 31 patients who underwent laparoscopic total adrenalectomy (group 2). The mean follow-up time was 32.3 months and 40.8 months, respectively. Patient’s preoperative characteristics, date during surgery, and postoperative clinical results of the two groups were analyzed.

In both groups of patients, laparoscopic adrenalectomy was successfully carried out. The laparoscopic partial adrenalectomy group had a shorter operation time when compared to total adrenalectomy ( P = .01). How - ever, patients in the laparoscopic total adrenalectomy group were older ( P = .04) and had a higher proportion of multiple adenomas ( P = .01) compared to partial adrenalectomy. Five patients (7.7%) who underwent partial ad - renalectomy did not show improvement in hypertension and/or serum potassium below normal levels, and review of plasma aldosterone concentration (PAC) and/or computerized tomography (CT) indicated that surgery was not successful in these patients. All 31 patients who underwent total adrenalectomy showed improvement or recovery from hypertension, and all PAC and serum potassium levels returned to normal levels after surgery.

Although both surgical procedures were technically safe and feasible, laparoscopic partial adrenalec - tomy showed a higher failure rate (7.7%) for patients with APA. Therefore, choosing laparoscopic partial adrenal - ectomy requires careful consideration, and we selected laparoscopic total adrenalectomy in patients with unilateral APA.

Laparoscopic adrenalectomy (LAD) is considered the gold standard surgical method for resecting adrenal tumors. To date, only few small studies have investigated the safety of clipless laparoscopic adrenalectomy in which the adrenal vessels were controlled by the LigaSure system or bipolar coagulation. The aim of the present study was to evaluate the safety and feasibility of sutureless and clipless laparoscopic adrenalectomy operations performed in our center.

All patients with functional adrenal tumors, nonfunctional adrenal tumors larger than 5 cm and secondary adrenal metastases from the kidneys, lungs or breasts who had underwent an LAD procedure between 2012 to 2019 were included in our study. In all of the cases, complete coagulation of adrenal veins was achieved through bipolar cautery and no vascular staplers, clips or other energy sources were used for controlling the adrenal vessels whatsoever. Outcomes of interest included operation time, length of hospital stay, changes of serum hemoglobin level, and occurrence of major complications.

Of a total 251 patients, unilateral right and left-side adrenalectomy was performed in 168 and 67 cases, respectively, and 16 cases had underwent bilateral adrenal resection. The mean age (SD) of patients was 40.7 (13.6) years old at the time of operation and the mean size (SD) of the adrenal lesions was 5.2 (3.1) cm as measured by the greatest diameter. Histological examination showed that the most common pathology of the resected adrenal glands was pheochromocytoma (n=78). None of the laparoscopic operations required a conversion to open surgery. Also, major bleeding or other serious complications did not occur in any of the cases either intraoperatively or postoperatively.

Clipless and sutureless laparoscopic adrenalectomy seems to be feasible and safe for removing adrenal tumors. Moreover, bipolar cautery is associated with an acceptable outcome for vessel closure

Adrenal myelolipoma is a rare benign tumor that is composed of hematopoietic cells and mature fat. Mostly, these nonfunctioning tumors are distinguished incidentally during autopsy or radiologic investigations. Here, we report a case of 46-year-old man presented with nonspecific abdominal pain for one year, who had right adrenal mass with fat density detected by radiologic investigation. Histopathological assessment of right adrenalectomy specimen revealed the diagnosis of adrenal myelolipoma.

Laparoscopic adrenalectomy is a safe procedure that was performed in 1992 for the first time. Morbid obesity is an independent risk factor for complications of adrenalectomy in postoperative period and conversion of laparoscopy to open procedure. Recent data show that laparoscopic adrenalectomy can reduce the recovery time, wound complications and hospital stay in morbidly obese and diabetic patients.

A 37-year-old morbidly obese diabetic female that was a candidate for bariatric surgery with chief complaint of right flank pain and large complex adrenal mass in preoperative ultrasonography confirmed by CT-scan and MRI was the case of this study. The patient underwent laparoscopic lateral transabdominal adrenalectomy and was discharged two days after operation without any complications. The pathologic study report was myelolipoma.

Laparoscopic adrenalectomy may be considered as a safe procedure in morbidly obese patients and can reduce the perioperative complications and recovery period in comparison with the open approach.