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Gama Filho JBD, Rodrigues DF, Mendes FF, Gama BL, Santos RBS, Corrêa LR, Borges JRJ, Silva LAFD, Paulo NM. LAPAROSCOPIC TECHNIQUE VERSUS OPEN TECHNIQUE IN SWINES ADRENALECTOMY. CIÊNCIA ANIMAL BRASILEIRA 2015. [DOI: 10.1590/1089-6891v16i219209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Among the main benefits of laparoscopic adrenalectomy (LA) compared to open adrenalectomy (OA) the rapid recovery of patients with decreased length of stay in hospital can be highlighted. The objective of this study was to compare the open adrenalectomy with laparoscopic adrenalectomy in swine. Thirty-two swine were operated. The animals had been divided into four groups (n = 8), one group was submitted to OA and the other to LA, together with its respective control group. Parameters were evaluated regarding operative time, body temperature, hematocrit, postoperative and intraoperative complications and time to deambulation. There was no meaningful difference between operative and deambulation times, even though the latter having been higher in the group submitted to OA. The most frequent intercurrences were in bowel, damage to adrenal vessels and renal hematoma. There were no significant blood losses, and observed hypothermia did not have any clinical impact. Laparoscopy in swine experimental adrenalectomy is a reliable technique that can serve as a reference for the surgical treatment of patients with adrenal diseases with surgical indications in other animal species.
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Ulmer TF, Binnebösel M, Mossdorf A, Neumann UP, Rosch R. Impact of pneumoperitoneum on collagen I expression in vitro. Eur Surg 2013. [DOI: 10.1007/s10353-013-0232-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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He HC, Dai J, Shen ZJ, Zhu Y, Sun FK, Shao Y, Zhang RM, Wang HF, Rui WB, Zhong S. Retroperitoneal adrenal-sparing surgery for the treatment of Cushing's syndrome caused by adrenocortical adenoma: 8-year experience with 87 patients. World J Surg 2012; 36:1182-1188. [PMID: 22382766 DOI: 10.1007/s00268-012-1509-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The objective of this study was to present our 8-year experience with partial adrenalectomy via the retroperitoneal approach for the treatment of Cushing's adenoma. METHODS A total of 93 patients who underwent adrenal surgery for Cushing's adenoma from March 2003 to December 2010 were enrolled in this study. Preoperative, intraoperative, and postoperative variables were reviewed from the database. Student's t test was used to analyze the continuous data, and the χ(2) test was used to analyze the categoric data. A value of p < 0.05 was considered statistically significant. RESULTS Adrenal-sparing surgery was performed in 87 cases (31 by open surgery, 56 by retroperitoneal laparoscopy). Six patients underwent open/laparoscopic total adrenalectomy because of recurrent disease or a large size. The cure rate in our series was 97.8%. Hypertension resolved in 34 of 64 patients (53.1%), diabetes in 7 of 27 patients (25.9%) and obesity in 28 of 48 patients (58.3%). One patient died during the postoperative period. The intraoperative complication rate for the open surgery group was significantly higher than that for the retroperitoneal laparoscopy group (9.1 vs. 1.7%). CONCLUSIONS The retroperitoneal approach is reliable and safe for treating Cushing's syndrome. The laparoscopic technique can decrease the prevalence of intraoperative complications. Retroperitoneal laparoscopic partial adrenalectomy can be performed with extremely low morbidity and achieves an excellent outcome, although death may occur during the postoperative period in high-risk patients. Postoperative management plays an important role in the surgical treatment of Cushing's syndrome.
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Affiliation(s)
- Hong-Chao He
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Jun Dai
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Zhou-Jun Shen
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Yu Zhu
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Fu-Kang Sun
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Yuan Shao
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Rong-Ming Zhang
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Hao-Fei Wang
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Wen-Bin Rui
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Shan Zhong
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
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Tiyadatah BN, Kalavampara SV, Sukumar S, Mathew G, Pooleri GK, Prasanna AT, Gopalakrishnan UA, Hattangadi SB. Bilateral Simultaneous Laparoscopic Adrenalectomy in Cushing's Syndrome: Safe, Effective, and Curative. J Endourol 2012; 26:157-63. [DOI: 10.1089/end.2011.0295] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Sudhir Sukumar
- Department of Urology, Amrita School of Medicine, Kochi, India
| | - Georgie Mathew
- Department of Urology, Amrita School of Medicine, Kochi, India
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Impact of pressure and gas type on adhesion formation and biomaterial integration in laparoscopy. Surg Endosc 2011; 25:3605-12. [PMID: 21643882 DOI: 10.1007/s00464-011-1766-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 04/18/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Laparoscopic mesh repair of inguinal and incisional hernias has been widely adopted. Nevertheless, knowledge about the impact of pneumoperitoneum on mesh integration is rare. The present study investigates pressure and gas-dependent effects of pneumoperitoneum on adhesion formation and biomaterial integration in a standardized animal model. METHODS Laparoscopic intraperitoneal onlay mesh implantation (IPOM) was performed in 32 female chinchilla rabbits using CO(2) or helium for pneumoperitoneum. Intra-abdominal pressures were 3 or 6 mmHg. Animals were killed after 21 days, and the abdominal wall was explanted for subsequent histopathological examinations. Adhesions were assessed qualitatively with a scoring system, and the adhesion surface was analyzed semiquantitatively by planimetry. Infiltration of macrophages (CD68), expression of matrix metalloproteinase 13 (MMP-13), and cell proliferation (Ki67) were analyzed at the mesh to host interface by immunohistochemistry. The collagen type I/III ratio was analyzed by cross-polarization microscopy to determine the quality of mesh integration. RESULTS After 21 days, perifilamental infiltration with macrophages (CD68) and percentage of proliferating cells (Ki67) were highest after 6 mmHg of CO(2) pneumoperitoneum. The extent of adhesions, as well as the expression of MMP-13 and the collagen type I/III ratio, were similar between groups. CONCLUSIONS Our experiments showed no pressure or gas-dependent alterations of adhesion formation and only minor effects on biomaterial integration. Altogether, there is no evidence for a clinically negative effect of CO(2) pneumoperitoneum.
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Porterfield JR, Thompson GB, Young WF, Chow JT, Fryrear RS, van Heerden JA, Farley DR, Atkinson JLD, Meyer FB, Abboud CF, Nippoldt TB, Natt N, Erickson D, Vella A, Carpenter PC, Richards M, Carney JA, Larson D, Schleck C, Churchward M, Grant CS. Surgery for Cushing's syndrome: an historical review and recent ten-year experience. World J Surg 2008; 32:659-77. [PMID: 18196319 DOI: 10.1007/s00268-007-9387-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Cushing's syndrome (CS), due to multiple etiologies, is a disorder associated with the ravages of cortisol excess. The purpose of this review article is to provide a historical synopsis of surgery for CS, review a recent 10-year period of operative management at a tertiary care facility, and to outline a practical approach to diagnosis and management. MATERIALS AND METHODS From 1996 to 2005, 298 patients underwent 322 operative procedures for CS at Mayo Clinic, Rochester, Minnesota. A retrospective chart review was carried out. Data was gathered regarding demographics, preoperative assessment, procedures performed, and outcomes. Data are presented as counts and percentages. Five-year survival rates were calculated where applicable by the Kaplan-Meier method. Statistical analysis was carried out with SAS, version 9 (SAS Institute, Inc., Cary, NC). RESULTS Two-hundred thirty-one patients (78%) had ACTH-dependent CS and 67 patients (22%) had ACTH-independent CS. One-hundred ninety-six patients (66%) had pituitary-dependent CS and 35 patients (12%) had ectopic ACTH syndrome. Fifty-four patients (18%) had cortisol-secreting adenomas, 10 patients (3%) had cortisol-producing adrenocortical carcinomas, and 1% had other causes. Cure rates for first time pituitary operations (transsphenoidal, sublabial, and endonasal) were 80% and 55% for reoperations. Most benign adrenal processes could be managed laparoscopically. Five-year survival rates (all causes) were 90%, 51%, and 23% for adrenocortical adenomas, ectopic ACTH syndrome, and adrenocortical carcinomas, respectively. CONCLUSIONS Surgery for CS is highly successful for pituitary-dependent CS and most ACTH-independent adrenal causes. Bilateral total adrenalectomy can also provide effective palliation from the ravages of hypercortisolism in patients with ectopic ACTH syndrome and for those who have failed transsphenoidal surgery. Unfortunately, to date, adrenocortical carcinomas are rarely cured. Future successes with this disease will likely depend on a better understanding of tumor biology, more effective adjuvant therapies and earlier detection. Clearly, IPSS, advances in cross-sectional imaging, along with developments in transsphenoidal and laparoscopic surgery, have had the greatest impact on today's management of the complex patient with CS.
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Affiliation(s)
- John R Porterfield
- Department of Surgery, Mayo Clinic and Mayo Foundation, 200 First Street, S.W, Rochester, MN 55905, USA
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Rosch R, Junge K, Binnebösel M, Mirgartz N, Klinge U, Schumpelick V. Improved abdominal wall wound healing by helium pneumoperitoneum. Surg Endosc 2008; 20:1892-6. [PMID: 17024535 DOI: 10.1007/s00464-005-0816-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2005] [Accepted: 04/05/2006] [Indexed: 04/10/2023]
Abstract
BACKGROUND Despite widespread use of the endoscopic technique in the treatment of inguinal and incisional hernias, knowledge about its impact on abdominal wall wound healing is rare. Questions remain regarding the risk of port-site hernias and hernia recurrence. The current study investigated the gas-dependent effects of pneumoperitoneum on laparotomy wound healing. METHODS Laparotomy was performed in 54 male Sprague-Dawley rats. A carbon dioxide (n = 18) or helium (n = 18) pneumoperitoneum of 3 mmHg was maintained before and after laparotomy, with an overall duration of 30 min. The rats in the control group (n = 18) received no pneumoperitoneum. The animals were killed after 5 and 10 days, and the abdominal wall was explanted for subsequent histopathologic examinations of the laparotomy wound. The granuloma formation in hematoxylin and eosin-stained sections was analyzed. Infiltration of macrophages (CD68) and expression of matrix metalloproteinases (MMP-8 and MMP-13) were examined by immunohistochemistry. The collagen type 1 to type 3 ratio was investigated by cross-polarization microscopy after Sirius Red staining. RESULTS After 5 and 10 days, the percentages of CD68-positive cells, granuloma formation, and expression of MMP-8 did not differ between the groups. In contrast, after both 5 and 10 days, the expression of MMP-13 and the collagen 1 to 3 ratio were significantly higher after helium pneumoperitoneum than in the control animals. CONCLUSION The results suggest that helium pneumoperitoneum may ameliorate wound healing within the abdominal wall and could therefore represent a beneficial gas for endoscopic hernia repair.
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Affiliation(s)
- R Rosch
- Department of Surgery, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
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Young, Jr. WF, Thompson GB. Role for laparoscopic adrenalectomy in patients with Cushing's syndrome. ACTA ACUST UNITED AC 2007; 51:1349-54. [DOI: 10.1590/s0004-27302007000800021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2007] [Accepted: 10/06/2007] [Indexed: 11/22/2022]
Abstract
Laparoscopic adrenalectomy is one of the most clinically important advances in the past 2 decades for the treatment of adrenal disorders. When compared to open adrenalectomy, laparoscopic adrenalectomy is equally safe, effective, and curative; it is more successful in shortening hospitalization and convalescence and has less long-term morbidity. The laparoscopic approach to the adrenal is the procedure of choice for the surgical management of cortisol-producing adenomas and for patients with corticotropin (ACTH) dependent Cushing's syndrome for whom surgery failed to remove the source of ACTH. The keys to successful laparoscopic adrenalectomy are appropriate patient selection, knowledge of anatomy, delicate tissue handling, meticulous hemostasis, and experience with the technique of laparoscopic adrenalectomy.
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Rosch R, Junge K, Binnebösel M, Mirgartz N, Klinge U, Schumpelick V. Gas-related impact of pneumoperitoneum on systemic wound healing. Langenbecks Arch Surg 2007; 393:75-80. [PMID: 17221267 DOI: 10.1007/s00423-006-0136-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Accepted: 11/21/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The aim of the present study was to investigate the gas-dependent effects of pneumoperitoneum on wound healing distant from the abdomen. MATERIALS AND METHODS Dorsal skin incisions were performed in 54 male Sprague-Dawley rats. A CO(2) or a helium pneumoperitoneum of 3 mmHg was maintained before, with an overall duration of 30 min (each n = 18). Rats in the control group received laparotomy only (n = 18). Animals were killed after 5 and 10 days. The infiltration of macrophages (CD 68), expression of matrix metalloproteinase 13 (MMP-13) and collagen I/III ratios were analysed in the dorsal skin wounds. RESULTS Both after 5 and 10 days, infiltration of macrophages and expression of MMP-13 were greatest after helium pneumoperitoneum. After 5 days, collagen I/III ratio was significantly increased in the helium group. After 10 days, collagen I/III ratio was lowest in the CO(2) group. CONCLUSION Our results suggest beneficial effects on systemic wound healing for helium pneumoperitoneum as compared to CO(2).
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Affiliation(s)
- R Rosch
- Department of Surgery, University Hospital Aachen, Aachen, Germany.
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Young WF, Thompson GB. Laparoscopic adrenalectomy for patients who have Cushing's syndrome. Endocrinol Metab Clin North Am 2005; 34:489-99, xi. [PMID: 15850855 DOI: 10.1016/j.ecl.2005.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Laparoscopic adrenalectomy is one of the most significant advances in the past 20 years for treating adrenal disorders. When compared with open adrenalectomy, laparoscopic adrenalectomy is equally safe, effective, and curative; it is more successful in shortening hospitalization and convalescence and has less long-term morbidity. The laparoscopic approach is the procedure of choice for the surgical management of cortisol-producing adenomas and for patients who have corticotropin (ACTH)-dependent Cushing's syndrome for whom surgery failed to remove the source of ACTH. The keys to successful laparoscopic adrenalectomy are appropriate patient selection, knowledge of anatomy, delicate tissue handling, meticulous hemostasis, and experience with the technique of laparoscopic adrenalectomy.
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Affiliation(s)
- William F Young
- Division of Endocrinology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Sidhu S, Gicquel C, Bambach CP, Campbell P, Magarey C, Robinson BG, Delbridge LW. Clinical and molecular aspects of adrenocortical tumourigenesis. ANZ J Surg 2003; 73:727-38. [PMID: 12956790 DOI: 10.1046/j.1445-2197.2003.02746.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Adrenal masses are a common problem affecting 3-7% of the population. The majority turn out to be benign adrenocortical adenomas, which may be functional or non-functional. Much more rarely, these masses represent a primary adrenal carcinoma. It is becoming increasingly recognized that of the benign functioning adenomas or hyperplasias, the majority will hypersecrete aldosterone and this will be more frequently detected when hypertensive populations are screened for this disease. In contrast, the incidence of primary adrenocortical carcinoma has remained steady and for this disease, surgery represents the mainstay of treatment. The advent of laparoscopic adrenal surgery has lowered the threshold size for recommending surgery for asymptomatic adrenal masses and as such, an increased proportion of adrenocortical cancers are being resected and detected at an earlier stage. Recent progress has been made in our understanding of the key genetic changes which underpin the biology of this disease. Progression from adrenal adenoma to carcinoma involves a monoclonal proliferation of cells which, among other defects, have undergone chromosomal duplication at the 11p15.5 locus leading to overexpression of the IGF2 gene and abrogation of expression of the CDKN1C and H19 genes. TP53 is involved in progression to carcinoma in a subset of patients and the frequency of ACTH receptor deletion needs to be more fully explored. Other key oncogenes and tumour suppressor genes remain to be identified although the chromosomal loci in which they lie can be identified at 17p, 1p, 2p16 and 11q13 for tumour suppressor genes and chromosomes 4, 5 and 12 for oncogenes.
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Affiliation(s)
- Stan Sidhu
- University of Sydney Endocrine Surgical Unit and Cancer Genetics, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia.
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Henry JF, Sebag F, Iacobone M, Hubbard J, Maweja S. [Lessons learned from 274 laparoscopic adrenalectomies]. ANNALES DE CHIRURGIE 2002; 127:512-9. [PMID: 12404845 DOI: 10.1016/s0003-3944(02)00831-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIMS To define the role of minimally invasive video-assisted surgery in the surgical management of adrenal disease and discuss the respective indications of the trans and retroperitoneal video assisted approaches. MATERIALS AND METHODS During the last 8 years (1994-2001), 330 adrenalectomies were performed in 305 patients: 274 (83%) laparoscopic approaches and 56 (17%) open approach. Open surgery was reserved for patients presenting with large or malignant tumours (29 cases), multiple and/or extraadrenal phaeochromocytomas (13 cases), previous intraabdominal intestinal surgery (10 cases), and in those requiring concomitant intraabdominal surgery (4 cases). Laparoscopic adrenalectomy was performed using the lateral transperitoneal approach for 89 Conn's syndrome, 67 Cushing's syndrome, 2 virilizing tumours, 51 phaeochromocytomas and 65 non secretory tumours greater than 4 cm in diameter. Nineteen patients underwent bilateral adrenalectomy. RESULTS There were no deaths. Twenty patients (7.3%) had a complication. Eleven cases required open conversion (4%) because of difficulties with dissection (8 cases), preoperative suspicion of malignancy (2 cases), and one pneumothorax. The average size of tumours was 34 mm (7-110 mm). There were 18 malignant tumours (6.5%): 8 adrenocortical carcinomas, 1 leiomyosarcoma, and 9 metastases. All patients with hormonally secreting tumours were cured of their endocrinopathy. There was 1 death secondary to hepatic metastases in a patient with an adrenocortical carcinoma. CONCLUSION Most adrenal tumours are suitable for video assisted excision. The only absolute contraindication is an invasive carcinoma requiring an extended excision. The lateral, transperitoneal approach is the most suitable for tumours greater than 5-6 cm in diameter. Both the transperitoneal or retroperitoneal approaches are suitable for smaller tumours depending on operator choice and experience. However in the presence of a large right lobe of liver or previous intraabdominal surgery the retroperitoneal approach may be preferable.
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Affiliation(s)
- J F Henry
- Service de Chirurgie Générale et Endocrinienne, Hôpital de la Timone, boulevard Jean-Moulin, 13385, Marseille, France.
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Abstract
The adrenals can be approached endoscopically using either transperitoneal or retroperitoneal access, most surgeons favouring the transperitoneal flank approach with the patient in the lateral decubitus position. Endoscopic retroperitoneal adrenalectomy can be performed via either a posterior or a lateral approach. The main advantage of the retroperitoneal approach in the prone position is that it allows bilateral adrenalectomy without repositioning the patient. Although technically more demanding, endoscopic adrenalectomy provides clear advantages over open procedures for tumours less than 5-6 cm in diameter. The small working space provided by the retroperitoneal approach is a contra-indication for the dissection of tumours over 5-6 cm in diameter. Peritoneal adhesions caused by previous abdominal surgery or a large right lobe of the liver may contra-indicate transperitoneal access. For small benign tumours, the transperitoneal and retroperitoneal routes are safe and effective, and there is no clear advantage of one procedure over the other. Invasive adrenal carcinoma is an absolute contra-indication for endoscopic adrenalectomy. Whether large (>5-6 cm) and potentially malignant tumours should be removed laparoscopically remains debatable.
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Affiliation(s)
- J F Henry
- General and Endocrine Surgery, Hospital La Timone, Marseilles, France
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Mirallié E, Leclair MD, de Lagausie P, Weil D, Plattner V, Duverne C, DeWint A, Podevin G, Héloury Y. Laparoscopic adrenalectomy in children. Surg Endosc 2001; 15:156-60. [PMID: 11285959 DOI: 10.1007/s004640000335] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The aim of this study was to describe the indications and results of laparoscopic adrenalectomy in children. METHODS This retrospective multicenter study included six children (four boys, two girls) aged 2-16 years (mean, 9.5). Three children had hypertension. In three cases, the adrenal mass was discovered incidentally. The tumors were bilateral in two children, right-sided in two cases, and left-sided in two cases. The mean tumor size was 4 cm (range, 1-7). Each child underwent MIBG scintigraphy and MRI before the operation. RESULTS Four right and two left adrenal glands were resected by laparoscopy (transperitoneal), and two left glands were resected by retroperitoneoscopy. Two conversions were necessary for two left adrenal glands (one retroperitoneoscopy, one laparoscopy). Two partial resections and six adrenalectomies were performed. Histological examination of the tumors revealed two ganglioneuromas, one neuroblastoma, and five pheochromocytomas (two bilateral). One child had an involved node (pheochromocytoma). Both bilateral pheochromocytomas had von Hippel-Lindau disease. There was no morbidity. Mean hospitalstay was 6 days. Postoperative evaluation at 1 month was normal in all children. CONCLUSION The indications for laparoscopic adrenalectomy in children are benign tumors and pheochromocytomas. In these cases, laparoscopic adrenalectomy is feasible and safe, even in cases of pheochromocytoma.
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Affiliation(s)
- E Mirallié
- Department of Pediatric Surgery, Hotel Dieu, Centre Hospitalier Universitaire, Nantes 44093, France
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Chow LW, Yuen KY, Woo PC, Wei WI. Clarithromycin attenuates mastectomy-induced acute inflammatory response. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2000; 7:925-31. [PMID: 11063500 PMCID: PMC95987 DOI: 10.1128/cdli.7.6.925-931.2000] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Based on the observation that administration of clarithromycin led to an attenuation of the inflammatory response induced by surgical trauma in a guinea pig model, we investigated the potential beneficial effects of clarithromycin on the local and systemic inflammatory response in patients undergoing mastectomy in an open-label prospective study. During a 16-month period, 54 patients who underwent mastectomy were randomly divided into two groups. In one group, the patients received oral clarithromycin at a dose of 500 mg twice a day, from the day before to 3 days after mastectomy. There was no significant difference in the incidence of antibiotic prophylaxis-related toxicities or postoperative infections between the patients who received clarithromycin and those who did not. Clarithromycin treatment was significantly associated with an attenuation of febrile response, tachycardia, tachypnea, and an increase in monocyte counts (P, <0.0001, <0.01, <0.05, and <0.01, respectively). Clarithromycin also reduced the intensity and duration of postoperative pain (P, <0.05 and <0.005, respectively) and increased the range of motion of the involved shoulder (P < 0.05 for abduction and flexion). We conclude that clarithromycin effectively modulates the acute inflammatory response associated with mastectomy and produces a better clinical outcome.
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Affiliation(s)
- L W Chow
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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