Our experience of laparoscopic partial adrenalectomy in surrenal adenomas

Year 2021, , 71 - 76, 08.09.2021

Murat Baki Yıldırım , Fahri Yetişir , Mesut Özdedeoğlu Ahmet Gürer Bülent Demirbaş Şemsi Mustafa Aksoy , Abdussamed Yalçın , Mehmet Kılıç

https://doi.org/10.47582/jompac.943502

Abstract

Aim: For adrenal lesions which are functional and bigger than four centimeters, the optional therapy is surgery. Laparoscopy for the surgery of adrenal masses is increasingly used today. In the past, total adrenalectomy was performed for any adrenal lesions without any exception; however, bilateral involvement of tumors like pheochromocytoma causes trouble and forced surgeons to try partial adrenalectomy. Recently, partial adrenalectomy is a routine surgical procedure for bilateral lesions and also becoming common for unilateral lesions. We aimed to present short-term results for patients who undergo laparoscopic total or partial adrenalectomy.
Material and Method: We collect data retrospectively for 33 patients who were operated on in our clinic for adrenal mass between January 2010 and December 2014. 3 patients were excluded from the study. All data were gained from personal patient medical records. Follow-up records were noted with one-by-one interviews by questioning steroid usage and symptoms of adrenal insufficiency.
Results: Patients were divided into two groups as total adrenalectomy group with 19 patients and partial adrenalectomy group with 11 patients. All patients who underwent total adrenalectomy have unilateral lesions, while 4 for 11 partial adrenalectomy patients have bilateral adrenal masses. Adrenal insufficiency developed in 3 patients for total adrenalectomy, 1 patient for unilateral partial adrenalectomy, and 1 patient for bilateral partial adrenalectomy.
Conclusion: Partial adrenalectomy appears to be protective for adrenal insufficiency for bilateral cases with a ratio of 75%. there was no significant difference between the total or partial unilateral adrenalectomy group, considering postoperative complications, recurrence rates, and insufficiency. As a result, laparoscopic partial adrenalectomy has similar results with less morbidity for unilateral lesions and an alternative method with less adrenal insufficiency for bilateral lesions. Laparoscopic partial adrenalectomy could be performed safely after the learning period was completed and should be considered for adrenal surgeries.

Keywords

adrenalectomy, adrenal insufficiency, cortex sparing surgery, laparoscopy.

Sürrenal adenomlarda laparoskopik parsiyel adrenalektomi deneyimimiz

Abstract

Amaç: Adrenal kitleler fonksiyonel ve 4 cm üzerindeyse ilk tercih adrenalektomidir. Günümüzde adrenal kitlelerin cerrahisi için laparoskopi yaygın olarak kullanılmaktadır. Tarihsel olarak adrenal kitleler için total adrenalektomi uygulanmıştır. Fakat bilateral tutulumu olan feokromasitoma gibi olgular nedeniyle ilk kez parsiyel adrenalektomi gündeme gelmiştir. Günümüzde bilateral olgularda parsiyel adrenalektomi rutin olarak uygulanmakta iken tek taraflı benign lezyonlarda da uygulanması giderek yaygınlaşmaktadır. Bu çalışmada laparoskopik total ve parsiyel adrenalektomi yapmış olduğumuz olguları kısa dönem sonuçlarını sunmayı amaçlıyoruz.
Gereç ve Yöntem: Çalışma Ocak 2010-Aralık 2014 tarihleri arasında adrenal kitle nedenli opere edilen hastaların verileri retrospektif olarak taranması ile yapılmıştır. Belitilen tarihler arasında 33 hastanın sürrenal adenoma nedenli ameliyata alındığı görülmüştür. Çalışmaya dahil edilme kriterlerine uymayan 3 hasta çalışma dışında bırakılmıştır. Çalışmaya dahil edilen 30 hastanın demografik verileri ve yapılan cerrrahi türü hasta dosyalarından öğrenilmiştir. Hastalar kontrole çağırılarak adrenal yetmezlik gelişip gelişmediği ve steroid replasman tedavisi alıp almadıkları sorgulanmıştır.
Bulgular: Çalışmaya alınan 30 hastanın 19’u total adrenalektomi yapıldığı, 11’i parsiyel adrenalektomi yapıldığı görüldü. Total adrenalektomilerinin hepsi unilateral iken parsiyel yapılan ameliyatların 7’si unilateral parsiyel 4’ü bilateral parsiyel adrenalektomi yapılmış olduğu görüldü. Total adrenalektomi yapılan hastaların postoperatif dönemde 3’ünde adrenal yetmezlik gelişirken unilateral parsiyel ve bilateral parsiyel adrenalektomi yapılan hasta gruplarınında birer hastada adrenal yetmezlik geliştiği görüldü.
Sonuçlar: Parsiyel adrenalektomi bilateral olgularda %75 oranında adrenal yetmezlikten korumuştur. Tek taraflı lezyonlarda da nüks, yetmezlik ve peroperatif komplikasyonlar açısından parsiyel ile total arasında fark yoktur. LPA öğrenme eğrisi tamamlandıktan sonra güvenle uygulanabilir. Bilateral adrenalektomi yapılan hastaların çoğunu yetmezlikten korur. Tek taraflı lezyonlarda uygulaması kolay ve hastaya bir zarar vermediği gibi muhtemel faydaları olaçağına inanıyoruz.

Keywords

Parsiyel Adrenalektomi, Korteks Koruyucu Adrenalektomi, Adrenal Yetmezlik

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