TECHNIQUE OF LAPAROSCOPIC ADRENALECTOMY - 11/09/11

Doi : 10.1016/S0094-0143(05)70393-1

Howard N. Winfield, MD ^{^{*
From the Departments of Urology (HNW, BDH) and Nephrology and Hypertension (ELB), Cleveland Clinic Foundation, Cleveland, Ohio}}, Blake D. Hamilton, MD ^{^{*
From the Departments of Urology (HNW, BDH) and Nephrology and Hypertension (ELB), Cleveland Clinic Foundation, Cleveland, Ohio}}, Emmanuel L. Bravo, MD ^{^{*
From the Departments of Urology (HNW, BDH) and Nephrology and Hypertension (ELB), Cleveland Clinic Foundation, Cleveland, Ohio}}

Résumé

In the past 15 years there have been significant advancements in minimally invasive surgery, best characterized by laparoscopic intervention. Urologic diagnostic applications of laparoscopy have existed since the mid-1970s, when it first was used to explore for nonpalpable testes.^{4 Cortesi N., Ferrari P., Zambarda E. , et al. Diagnosis of bilateral abdominal cryptorchidism by laparoscopy Endoscopy 1976 ; 8 : 33 [cross-ref]

Cliquez ici pour aller à la section Références} It was not until the early 1990s, however, with improvement in video-optics and instrumentation, that laparoscopic surgery gained real credibility. Since then, laparoscopic pelvic lymph node dissection,^{15 Winfield H.N., Donovan J.F., See W.A. , et al. Laparoscopic pelvic lymph node dissection for genitourinary malignancies: Indications, techniques and results J Endourol 1992 ; 6 : 103 [cross-ref]

Cliquez ici pour aller à la section Références} varix ligation,^{5 Donovan J.F., Winfield H.N. Laparoscopic varix ligation J Urol 1992 ; 147 : 77

Cliquez ici pour aller à la section Références} nephrectomy,^{3 Clayman R.V., Kavoussi L.R., Soper N.J. , et al. Laparoscopic nephrectomy N Engl J Med 1991 ; 324 : 1370

Cliquez ici pour aller à la section Références} bladder neck suspension,^{1 Albala D.M., Schuessler W.W., Vancaillie T.G. Laparoscopic bladder neck suspension J Endourol 1992 ; 6 : 137 [cross-ref]

Cliquez ici pour aller à la section Références} pyeloplasty,^{12 Schuessler W.W., Grune M.T., Techuanhuey L.V. , et al. Laparoscopic dismembered pyeloplasty J Urol 1993 ; 150 : 1795

Cliquez ici pour aller à la section Références} and an ever-growing list of extirpative and reconstructive urologic procedures have been performed and evaluated.^{8 Gill I.S., Clayman R.V., McDougall E.M. Advances in urological laparoscopy J Urol 1995 ; 154 : 1275 [cross-ref]

Cliquez ici pour aller à la section Références}

With the improvement of cross-sectional imaging (CT and MR imaging scans), incidental adrenal lesions are detected more commonly, whereas functioning adrenal tumors continue to be rare but they normally require medical or surgical treatment. Open adrenalectomy may be performed by a posterior, flank, or transperitoneal anterior approach; however, in many cases a substantial incision must be made to access the deep retroperitoneal location of the often small and elusive adrenal tumor. Postoperative pain is considerable, often requiring the use of epidural catheters for analgesia. Increased risk of infection, especially in patient's with Cushing's syndrome, may result because of large painful incisions in the upper abdomen with development of atelectasis and pneumonia. Morbidity of open adrenalectomy has been reported to be as high as 40%, with mortality in the range of 2% to 4%.^{10 McLeod M.K. Complications following adrenal surgery J Natl Med Assoc 1991 ; 83 : 161

Cliquez ici pour aller à la section Références, 11 Sarkar R., Thompson N.W., McLeod M.K. The role of adrenalectomy in Cushing's syndrome Surgery 1990 ; 108 : 1079

Cliquez ici pour aller à la section Références}

The laparoscopic approach to the adrenal gland offers a minimally invasive procedure with markedly improved postoperative characteristics. Laparoscopic adrenalectomy first was reported by Gagner^{7 Gagner M., Lacroix A., Prinz R.A. , et al. Early experience with the laparoscopic approach for adrenalectomy Surgery 1993 ; 114 : 1120

Cliquez ici pour aller à la section Références} in 1992 and has subsequently been found to have great use among European and Asian urologists.^{9 Guazzonni G., Montirsi F., Bocciardi A. , et al. Transperitoneal laparoscopic versus open adrenalectomy for benign hyperfunctioning adrenal tumors: A comparative study J Urol 1995 ; 153 : 1597

Cliquez ici pour aller à la section Références, 13 Suzuki K., Kageyama S., Veda D. , et al. Laparoscopic adrenalectomy: Clinical experience with 12 cases J Urol 1993 ; 150 : 1099

Cliquez ici pour aller à la section Références}