Osp. Ital. Chir. 2011;17:206-11
Accesso sotto-mesocolico nella surrenalectomia laparoscopica sinistra.
Marcello Paci’ , Giancarlo D’Ambrosio’ , Daniele Scoglio’ , Pietro Ursi’, Giovanni Lezoche? , Bernardina Fabiani’ , Salvatore Campo’, Edoardo de Werra?, Andrea Balla’, Alessandro Maria Paganini’.
Submesocolic approach in left laparoscopic adrenalectomy
Laparoscopic adrenalectomy (LA) has become the standard treatment of adrenal lesions but the choice of the approach (lateral transperitoneal, posterior retroperitoneal, anterior transperitoneal) is still controversial.
The aim of this study was to report our experience with the an- terior transperitoneal approach, especially for left adrenal lesions, for which we always propose an anterior, submesocolic approach.
From January 1994 to January 2009 111 males and 178 females with a mean age of 50.48 years (range: 17-84) underwent LA at 2 centers in Ancona and Rome (Italy). Thirteen patients underwent bilateral LA. The anterior transperitoneal approach was used in 221 cases (1 open; 73.2%), the right lateral approach was used in 13 cases (4.3%), the left lateral approach was used in 2 cases (0.6%), and the anterior submesocolic approach in 59 cases (1 open; 19.6%) Of the 58 patients who underwent left LA using the submeso- colic approach, 33 were females and 25 males with a mean age of 50.95 years (range: 25-76). Thirty patients had Conn’s syndrome, 7 had pheochromocytomas, 9 had incidentalomas, 10 had Cushing’s syndrome, and 2 had metastatic masses. The lesions had a mean di- ameter of 2.85 cm (range: 2-4).
Indirizzo per la corrispondenza:
Dott. Daniele Scoglio
Unità di Chirurgia Endolaparoscopica e Tecnologia Avanzata Policlinico Umberto I
Viale del Policlinico, 155 – 00161 Roma
Tel.: 06-49978851 – Fax: 06-49978849
‘ Unità di Chirurgia Endolaparoscopica e Tecnologia Avanzata Dipartimento di Chirurgia “Paride Stefanini” Policlinico Umberto | – Roma
? Clinica di Chirurgia Generale e Metodologia Chirurgica Università Politecnico delle Marche – Ancona
Mean operating time was 104 minutes (range: 58-240). Conver- sion to open surgery was required in 2 cases due to visceral obesity in one case and proximity of the adrenal lesion to the inferior vena cava in the other case. Blood pressure and heart rate were signifi- cantly more stable than those of patients operated on using the an- terior or lateral transperitoneal approaches. There were neither ma- jor complications nor mortality. Mobilization and resumption of di- et occurred on the first postoperative day. Mean hospital stay was 4.5 days (range: 2-20).
Left adrenal masses can be successfully treated using a laparo- scopic anterior submesocolic approach. We consider early identifi- cation and ligation of the adrenal vein, with minimal gland manip- ulation, especially in the presence of pheochromocytomas, as the most important advantage of the submesocolic approach.
Key words: laparoscopic adrenalectomy, adrenal tumors, pheochro- mocytoma.
La ghiandola surrenalica è situata in profondità nel retroperitoneo e in chirurgia open, per raggiungerla, è necessario praticare un’ampia incisione. L’avvento delle tecniche mini-invasive ha cambiato l’approccio chirurgico al surrene e, dalla descrizione di Gagner nel 1992, l’uso della laparoscopia per la surre- nalectomia si è notevolmente esteso. Come riportato in letteratura, sono state impiegate molte tecniche laparo-……… segue
Osp Ital Chir – Aprile-Giugno 2011