Elektif Laparoskopik Adrenalektomilerde Lateralizasyon Farklılıkları

Abstract

Amaç: Laparoskopi, adrenal tümörlerin çıkartılmasında güvenilirliği birçok kez bildirilmiş etkili bir minimal invaziv yöntemdir. Çalışma, laparoskopik adrenalektominin sağ-sol taraf farkına bağlı olarak karşılaşılan klinik özelliklerin gösterilmesini hedeflemektedir.Gereç ve Yöntemler: Çalışmada Ocak 2014 ile Aralık 2018 arasında üniversitemiz genel cerrahi kliniğinde transperitoneal yolla laparoskopik tek taraflı adrenalektomi yapılan erişkin hastalar, lateralizasyon farklılıklarını tespit etmek üzere analiz edilmektedir. Hastaların demografik ve klinik bilgileri, ameliyata ilişkin verileri, yatış süresi, ameliyat sırası ve sonrasındaki komplikasyonları ile patoloji sonuçları analiz edilmiştir. Bulgular: Çalışmaya 96’sı kadın %76 , 31’i erkek %24 127 hasta alındı. Yaş ortalamaları 53’tü SS:±13 . Preoperatif tanı 51 hastada %40,2 Cushing sendromu, 45 hastada %35,4 hormonal aktivite izlenmeyen non-spesifik kitle, 15 hastada %11,8 Conn sendromu, 7 hastada %5,5 benign ve 5 hastada %3,9 malignite şüpheli feokromasitoma, 2 hastada %1,6 metastaz, 1 hastada %0,8 kortikal karsinom, 1 hastada ise %0,8 teratomdu. Biri bilateral 82 hastada %64,6 radyolojik olarak adenom, 16 hastada %12,6 non-spesifik kitle, 8 hastada %6,3 feokromasitoma dışı malignite şüpheli kitle, 7 hastada %5,5 nodül, 5 hastada %3,9 kistik kitle ve 3 hastada %2,4 malignite şüpheli feokromasitoma saptandı. Ortanca tümör çapı 32 mm idi Çeyrekler arası aralık ÇAA : 21-42 . Sonuç: Lateral yaklaşımla hastaya lateral dekübit pozisyon verilerek uygulanan laparoskopik adrenalektomilerde sol taraf girişimlerde daha sık komplikasyon gelişmektedir. Çoğunlukla geniş disseksiyona bağlı kanamalara sekonder gelişen bu komplikasyonlar bu taraf lezyonlarda farklı cerrahi teknik veya ilave tedbirler alınması ihtiyacını vurgulamaktadır

Keywords

• Adrenalektomi, Laparoskopik cerrahi, Laparoskopik adrenalektomi

Lateralization Differences in Elective Laparoscopic Adrenalectomies

Abstract

Objective: Reportedly, laparoscopy is an effective and safe minimally invasive method for adrenal tumors. The aim of this study was to demonstrate the right-left lateralization differences in the clinical features of laparoscopic adrenalectomy.Material and Methods: Adult patients who underwent transperitoneal laparoscopic unilateral adrenalectomy in the general surgery department of our university, between January 2014 and December 2018, were analyzed in order to determine the differences in lateralization. Demographic and clinical information, surgical data, length of stay, complications during and after surgery, and pathology results were analyzed.Results: A total of 127 patients, 96 female 76% and 31 male 24% , were included in the study. The mean age was 53 SD:±13 years. The preoperative diagnosis was Cushing's syndrome in 51 patients 40.2% , non-specific mass without hormonal activity in 45 patients 35.4% , Conn syndrome in 15 patients 11.8% , benign pheochromocytoma in 7 patients 5.5% , pheochromocytoma with malignancy suspicion in 5 patients 3.9% , metastasis in 2 patients 1.6% , cortical carcinoma in 1 patient 0.8% and teratoma in 1 patient 0.8% . Radiological diagnosis was radiological adenoma in 82 patients 64.6% , non-specific mass in 16 patients 12.6% , non-pheochromocytoma malignancy in 8 patients 6.3% , nodules in 7 5.5% patients, cystic mass in 5 patients 3.9% and pheochromocytoma with malignancy suspicion in 3 patients 2.4% . The median tumor diameter was 32 mm .Conclusion: Patients had more frequent complications in the lateral-approach left laparoscopic adrenalectomies. These complications, which were mostly secondary to bleeding after extensive dissection, emphasize the need for a different surgical technique or additional measures

Keywords

• Adrenalectomy, Laparoscopic surgery, Laparoscopic adrenalectomy

References

1. Gagner M, Lacroix A, Bolte´ E. Laparoscopic adrenalectomy pheochromocytoma. N Engl J Med 1992; 327:1033.
2. Smith CD, Weber CJ, Amerson JR. Laparoscopic adrenalectomy: New gold standard. World J Surg 1999; 23: 389-96.
3. Elfenbein DM, Scarborough JE, Speicher PJ, Scheri RP. Comparison of laparoscopic versus open adrenalectomy: results from American College of Surgeons-National Surgery Quality Improvement Project. J Surg Res 2013; 184(1):216-20.
4. Callender GG, Kennamer DL, Grubbs EG, Lee JE, Evans DB, Perrier ND. Posterior retroperitoneoscopic adrenalectomy. Adv Surg 2009; 43:147-57.
5. Stefanidis D, Goldfarb M, Kercher KW, Hope WW, Richardson W, Fanelli RD. Society of Gastrointestinal and Endoscopic Surgeons. SAGES guidelines for minimally invasive treatment of adrenal pathology. Surg Endosc 2013; 27(11):3960-80.
6. Carr AA, Wang TS. Minimally invasive adrenalectomy. surg. Oncol Clin N Am 2016; 25(1):139-52.
7. Balla A, Ortenzi M, Palmieri L, Corallino D, Meoli F, Ursi P, Puliani G, Sbardella E, Isidori AM, Guerrieri M, Quaresima S, Paganini AM. Laparoscopic bilateral anterior transperitoneal adrenalectomy: 24 years experience. Surg Endosc 2019. DOI: 10.1007/s00464- 019-06665-6.
8. Marescaux J, Mutter D, Wheeler MH. Laparoscopic right and left adrenalectomies. Surgical procedures. Surg Endosc 1996; 10(9):912-5.

9. Meyer G, Schardey HM, Schildberg FW. Die laparoskopische Chirurg 1995; 66:413-8. Adrenalectomie.
10. Terachi T, Yoshida O, Matsuda T, Orikasa S, Chiba Y, Takahashi K, Takeda M, Higashihara E, Murai M, Baba S, Fujita K, Suzuki K, Ohshima S, Ono Y, Kumazawa J, Naito S. Complications of laparoscopic and retroperitoneoscopic adrenalectomies in 370 cases in Japan: A multi-institutional study. Biomed Pharmacother. 2000; 54 Suppl 1:211-4.
11. Kokorak L, Soltes M, Vladovic P, Marko L. Laparoscopic left and right adrenalectomy from an anterior approach - is there any difference? Outcomes in 176 consecutive patients. Wideochir Inne Tech Maloinwazyjne 2016; 11(4):268-73.
12. Cianci P, Fersini A, Tartaglia N, Altamura A, Lizzi V, Stoppino LP, Macarini L, Ambrosi A, Neri V. Spleen assessment after laparoscopic transperitoneal left adrenalectomy: preliminary results. Surg Endosc 2016; 30(4):1503-7.
13. Ghali F, Hyams ES. Heterotopic pancreatic tail appearing as adrenal mass in a patient with left pelvic kidney. Urology 2015; 85(5):e37-e38.
14. Varkarakis IM, Allaf ME, Bhayani SB, Inagaki T, Su LM, Kavoussi LR, Jarrett TW. Pancreatic injuries during laparoscopic urologic surgery. Urology 2004; 64(6):1089- 93.
15. Aksakal N, Agcaoglu O, Barbaros U, Tukenmez M, Dogan S, Kilic B, Erbil Y, Seven R, Ozarmagan S, Mercan S. Safety and feasibility of laparoscopic adrenalectomy: What is the role of tumour size? A single institution experience. J Minim Access Surg 2015; 11(3):184-6.
16. Zeiger MA, Thompson GB, Duh QY, Hamrahian AH, Angelos P, Elaraj D, Fishman E, Kharlip J; American Association of Clinical Endocrinologists; American Association of Endocrine Surgeons. Medical Guidelines for the Management of Adrenal Incidentalomas: Executive summary of recommendations. Endocr Pract 2009; 15(5):450-3.
17. Gaujoux S, Mihai R; Joint working group of ESES; ENSAT. European Society of Endocrine Surgeons (ESES) and European Network for the Study of Adrenal Tumours (ENSAT) recommendations for the surgical management of adrenocortical carcinoma. Br J Surg 2017; 104(4):358- 76.