Technical modification of retroperitoneal laparoscopic adrenalectomy for primary hyperaldosteronism and clinical outcomes

Yi Chia Lin, Hsin Yi Lee, Guang Dar Juang, Chung Hsin Yeh, Yi Hong Cheng, Kuang Yu Chuo, Hong En Chen, Te Fu Tsai, Yi-Sheng Huang

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background/Objective: Standard laparoscopic adrenalectomy requires early control of the main adrenal vein; however, the small retroperitoneal working space is challenging for beginners to perform this maneuver. We report a technical modification of retroperitoneal laparoscopic adrenalectomy (RLA) for primary hyperaldosteronism (PHA) and the clinical outcomes. Methods: A total of 38 RLAs were performed for the patients with PHA. The patients were placed in true lateral position with mild bending to expand the surgical field. Instead of attempting to control the main adrenal vein initially, we adopted a technical modification that manipulating and freeing the gland first before controlling the main adrenal vein. Results: The RLAs were successfully performed in all but one case, which was converted to open surgery due to pancreatic injury. Mean operative time was 124 minutes and estimated blood loss was 74 ml. Mean maximal fluctuation of systolic blood pressure was 29 mmHg. For the right-side RLA, less operative time (113.5 vs. 137.9 minutes) and estimated blood loss (59.5 vs. 91.2 ml) were noted compared with the left-side procedure. Postoperative complications included cerebrovascular accident in one patient, one surgical site hematoma, and two patients had postoperative fever. Potassium level returned to normal in all patients and 70% of the patients reduced their antihypertensives. Conclusion: Technical modification RLA for PHA without initial control of the main adrenal vein is a safe and feasible procedure. No vigorous blood pressure fluctuation was intraoperatively noted. No vascular injury occurred. Moreover, the right-side procedure became easier.

Original languageEnglish
Pages (from-to)20-25
Number of pages6
JournalAsian Journal of Surgery
Volume36
Issue number1
DOIs
Publication statusPublished - Jan 2013

Fingerprint

Hyperaldosteronism
Adrenalectomy
Veins
Operative Time
Blood Pressure
Retroperitoneal Space
Vascular System Injuries
Hematoma
Antihypertensive Agents
Potassium
Fever
Stroke
Wounds and Injuries

Keywords

  • laparoscopic adrenalectomy
  • outcome
  • primary hyperaldosteronism
  • retroperitoneum

ASJC Scopus subject areas

  • Surgery

Cite this

Technical modification of retroperitoneal laparoscopic adrenalectomy for primary hyperaldosteronism and clinical outcomes. / Lin, Yi Chia; Lee, Hsin Yi; Juang, Guang Dar; Yeh, Chung Hsin; Cheng, Yi Hong; Chuo, Kuang Yu; Chen, Hong En; Tsai, Te Fu; Huang, Yi-Sheng.

In: Asian Journal of Surgery, Vol. 36, No. 1, 01.2013, p. 20-25.

Research output: Contribution to journalArticle

Lin, YC, Lee, HY, Juang, GD, Yeh, CH, Cheng, YH, Chuo, KY, Chen, HE, Tsai, TF & Huang, Y-S 2013, 'Technical modification of retroperitoneal laparoscopic adrenalectomy for primary hyperaldosteronism and clinical outcomes', Asian Journal of Surgery, vol. 36, no. 1, pp. 20-25. https://doi.org/10.1016/j.asjsur.2012.08.002
Lin, Yi Chia ; Lee, Hsin Yi ; Juang, Guang Dar ; Yeh, Chung Hsin ; Cheng, Yi Hong ; Chuo, Kuang Yu ; Chen, Hong En ; Tsai, Te Fu ; Huang, Yi-Sheng. / Technical modification of retroperitoneal laparoscopic adrenalectomy for primary hyperaldosteronism and clinical outcomes. In: Asian Journal of Surgery. 2013 ; Vol. 36, No. 1. pp. 20-25.
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AB - Background/Objective: Standard laparoscopic adrenalectomy requires early control of the main adrenal vein; however, the small retroperitoneal working space is challenging for beginners to perform this maneuver. We report a technical modification of retroperitoneal laparoscopic adrenalectomy (RLA) for primary hyperaldosteronism (PHA) and the clinical outcomes. Methods: A total of 38 RLAs were performed for the patients with PHA. The patients were placed in true lateral position with mild bending to expand the surgical field. Instead of attempting to control the main adrenal vein initially, we adopted a technical modification that manipulating and freeing the gland first before controlling the main adrenal vein. Results: The RLAs were successfully performed in all but one case, which was converted to open surgery due to pancreatic injury. Mean operative time was 124 minutes and estimated blood loss was 74 ml. Mean maximal fluctuation of systolic blood pressure was 29 mmHg. For the right-side RLA, less operative time (113.5 vs. 137.9 minutes) and estimated blood loss (59.5 vs. 91.2 ml) were noted compared with the left-side procedure. Postoperative complications included cerebrovascular accident in one patient, one surgical site hematoma, and two patients had postoperative fever. Potassium level returned to normal in all patients and 70% of the patients reduced their antihypertensives. Conclusion: Technical modification RLA for PHA without initial control of the main adrenal vein is a safe and feasible procedure. No vigorous blood pressure fluctuation was intraoperatively noted. No vascular injury occurred. Moreover, the right-side procedure became easier.

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