Recently, single port laparoscopic surgery has been the focus of attention due to the advanced laparoscopic skills accumulated from experience and developments in laparoscopic instruments. Herein, we present two cases of initial single port laparoscopic adrenalectomies. Case 1 was a 38-year-old female patient diagnosed with primary hyperaldosteronism because of a the right adrenal 2.5-cm sized adenoma, and case 2 was a 31-year-old female patient diagnosed with primary adrenal Cushing's syndrome because of a left adrenal 2.9-cm sized adenoma. Both patients successfully underwent single port laparoscopic adrenalectomies via a transumbilical transperitoneal approach. There was no estimated blood loss and the total operating times were 60 and 70 minutes, respectively. Both patients recovered uneventfully. We believe that this technique presented could provide potential benefits (lesser wound pain, better cosmetic satisfaction, and shorter convalescence) if the indications are carefully selected.
Adrenal Glands/surgery ; Adrenalectomy/*methods ; Adult ; Cushing Syndrome/surgery ; Female ; Humans ; Hyperaldosteronism/surgery ; Laparoscopy/*methods

BACKGROUNDAlveolar echinococcosis located in the adrenal gland can be considered a rare and aggressive infestation that radiologically and macroscopically mimics a malignant neoplasm. Its pathogenesis is poorly understood. This paper describes its clinical and radiological aspects and discusses its proper management.

METHODSThe records of two patients with adrenal gland alveolar echinococcosis who were diagnosed and treated in our center in 2009 were evaluated.

RESULTSNeither patient showed any signs of recurrence following radical surgical treatment and postoperative oral anthelmintic therapy.

CONCLUSIONRadical surgery can be a feasible, effective management option that results in a good prospective outcome.

Adrenal Glands ; pathology ; surgery ; Echinococcosis, Hepatic ; diagnosis ; surgery ; Female ; Humans ; Male ; Middle Aged

PURPOSE: Laparoscopic adrenalectomy has become the procedure of choice to remove a wide variety of adrenal tumors. The laparoscopic approaches to the adrenal gland include a lateral (transperitoneal) approach and the posterior (retroperitoneal) approach. The aim of the present study is to compare the clinical outcomes from both methods. METHODS: Between January 2000 and October 2008, we performed 60 laparoscopic adrenalectomies, including 29 posterior retroperitoneal approaches (RLA) and 31 lateral transperitoneal approaches (TLA). RESULTS: Sixty patients were treated for the following conditions: adrenocortical adenoma: 35 patients, pheochromocytoma: 19 patients, organizing hematoma: 2 patients, ganglioneuroma: 2 patients, myelolipoma: 1 patient and adrenal oncocytoma: 1 patient. The average tumor size was 3.2+/-1.4 cm in the TLA patient group and 2.9+/-1.4 cm in the RLA patient group. In the TLA group, the procedures were performed with the patients in the lateral position, and the patients were in the prone position in the RLA group. The average operation time of the RLA group was significantly shorter than that of the TLA group. The RLA group had a shorter postoperative hospital stay, they required less postoperative pain control and they resumed a full diet earlier. Conversion to open surgery was required in five patients (16%) in the TLA group. Complications occurred in five patients of the TLA group and in five patients of the RLA group. No mortality was observed in both groups. CONCLUSION: For experienced surgeons, if the adrenal tumor is less than 6 cm in size, posterior retroperitoneal adrenalectomy may be a safer and faster procedure, so it should be considered as the first choice of operation of benign adrenal tumors.
Adrenal Glands ; Adrenalectomy ; Conversion to Open Surgery ; Diet ; Humans ; Length of Stay ; Pain, Postoperative ; Prone Position

OBJECTIVE: The adrenal gland is small and located in difficult area to approach, anatomically. Laparoscopic adrenalectomy (LA) is considered as a best approach for the treatment for adrenal tumors. However, its role in removal of larger tumor (>5 cm) is still questioned due to concerns of complexity of procedure. We evaluate technical feasibility and analyze the outcome of LA for large adrenal masses. METHODS: The data of 36 patients who underwent LA for adrenal mass were analyzed for this study. Group 1 (n=27, mean diameter=2.43 cm) consisted of tumors smaller than 5 cm and group 2 (n=9, mean diameter=5.64 cm) consisted of larger than 5 cm. The length of operation time, estimated blood loss, analgesics usage, length of hospital stay, histopathology, tumor size, and perioperative complications were compared. RESULTS: All operation was completed safely and no one required conversion to open surgery. Group 1 (146.48 minutes) had a significantly shorter mean operative time compared to group 2 (181.00 minutes) (P<0.05). There was no significant difference in the postoperative hospital stay, time to remove the drainage, estimated blood loss, and the number of analgesics usage. No major complication was occurred during and after operation but one case of pulmonary congestion was occurred in group 2. Histopathologic findings were 20 cortical adenomas (55.6%), 3 cystic lesions (8.3%), and 3 malignant lesions (8.3%). CONCLUSION: LA is safe and feasible for large adrenal tumors without local invasion. The size of an adrenal tumor should not be the primary factor in determining whether a LA should be performed.
Adenoma ; Adrenal Glands ; Adrenalectomy* ; Analgesics ; Conversion to Open Surgery ; Drainage ; Estrogens, Conjugated (USP) ; Humans ; Laparoscopy ; Length of Stay ; Operative Time

Adrenal Glands ; metabolism ; Androgens ; metabolism ; Gene Amplification ; Humans ; Male ; Orchiectomy ; Prostatic Neoplasms ; metabolism ; pathology ; surgery ; Receptors, Androgen ; metabolism

Adrenal Gland Neoplasms ; pathology ; surgery ; Adrenal Glands ; pathology ; surgery ; Child, Preschool ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Granuloma, Plasma Cell ; pathology ; surgery ; Histiocytoma, Malignant Fibrous ; pathology ; Humans ; Neoplasms, Muscle Tissue ; pathology ; surgery

OBJECTIVETo investigate the factors regarding the recovery of postoperative blood pressure of aldosterone producing adenoma (APA) patients.

METHODSSixty-eight patients with APA were recruited and their data including retinal blood vessel by Doppler sonography, urinary trace albumin, pathological changes of renal biopsy and the adrenal tissues around the adenoma were analyzed in order to determine the correlation between these data and postoperative durative hypertension.

RESULTSPostoperative durative hypertension occurred in 14 cases (41.2%) with increased resistance of unilateral or bilateral central artery of retina, in 16 cases (66.7%) with increased level of urinary trace albumin. Fifteen cases underwent renal biopsy and all of them showed different pathological alterations, 11 cases (73.3%) of which presented with postoperative durative hypertension. The pathological changes of the adrenal tissues around the adenoma is either atrophy or non-atrophy (normal or hyperplasia), 8 cases (40%) and 10 cases (22.2%) of which showed postoperative durative hypertension, respectively.

CONCLUSIONThe renal pathological changes and increased resistance of retinal blood vessel are the main reasons leading to postoperative hypertension in patients with APA.

Adolescent ; Adrenal Cortex Neoplasms ; physiopathology ; surgery ; Adrenal Glands ; pathology ; Adrenocortical Adenoma ; physiopathology ; surgery ; Adult ; Blood Pressure ; physiology ; Female ; Humans ; Hyperaldosteronism ; etiology ; physiopathology ; surgery ; Hypertension ; etiology ; Kidney ; pathology ; Male ; Middle Aged ; Postoperative Period ; Retinal Artery ; physiopathology ; Retrospective Studies ; Vascular Resistance ; physiology

Pheochromocytoma is one of the potentially fatal causes of childhood hypertension. The study aims to analyze the results of our experiences in pheochromocytomas and the long-term results of its surgical treatment in children. The records of 15 children (11 boys, 4 girls) treated for pheochromocytoma in our unit during the period of 1984 and 2002 were reviewed retrospectively. The average age at surgery was 11.7 yr (range 6 yr 9 months-15 yr 7 months). Localized disease is defined as the cases without the invasion of surrounding tissue, regional disease as the invasion of surrounding tissue and metastatic disease as distant metastases. The mean follow-up after pheochromocytoma excision was 95 months (range 5 to 221 months). Tumors were located in the adrenal gland in 11 (bilaterally in 4) and extra-adrenally in 4. Localized disease occurred in 14 patients and regional disease in one. Only one patient was associated with von Hippel Lindau syndrome. Adrenalectomy or total excision of extra adrenal tumor was performed. Four patients (26.7%) recurred after the first operation (at 2 yr 9 months to 14 yr) and regional disease recurred in one patient three times. Early diagnosis, surgical excision, and long-term follow up are most important for the appropriate treatment of childhood pheochromocytoma.
Adolescent ; Adrenal Gland Neoplasms/surgery ; Adrenal Glands/pathology ; Adrenalectomy ; Child ; Chromaffin Cells/pathology ; Female ; Follow-Up Studies ; Hippel-Lindau Disease/pathology ; Human ; Hypertension/etiology ; Male ; Neoplasm Metastasis ; Pheochromocytoma/*surgery ; Recurrence ; Retrospective Studies ; Time Factors ; Treatment Outcome

PURPOSE: A laparoscopic procedure is considered the treatment of choice for an adrenalectomy. We report our experience of a laparoscopic transperitoneal adrenalectomy in a series of 41 patients. MATERIALS AND METHODS: Between February 1999 and September 2004, 41 consecutive patients underwent a laparoscopic transperitoneal adrenalectomy. The indications for a adrenalectomy were primary aldosteronism in 16 patients, Cushing's syndrome in 7, pheochromocytoma in 6, nonfunctional adenoma in 5, adrenal cyst in 3, benign cystic teratoma in 2, myelolipoma in 1 and metastatic renal cell carcinoma in 1. The author analyzed the results of each operation. RESULTS: The affected adrenal gland was successfully removed, with the exception of 3 cases. Conversion to open surgery was necessary in 3 of the pheochromocytoma patients due to massive intraoperative bleeding and severe adhesion to retroperitoneal fat. The mean operative time was 245.3 minutes (125-420). The mean intraoperative blood loss and adrenal mass size were 189.6ml (20-2100) and 3.6cm (1.0-10.4), respectively. The mean post-operative hospital stay was 10.4 days (5-29). The mean times to oral intake and ambulation were 1.4 (1-3) and 1.0 days (1-2) after the operation, respectively. The mean number of days of analgesic administration was 2.1 (0-6). The conversion and major complication rates were 7.3 and 10.5%, respectively. CONCLUSIONS: A laparoscopic adrenalectomy is safe and effective in nearly all adrenal pathologies, with early oral intake, ambulation and a low number of days of pain control.
Adenoma ; Adrenal Glands ; Adrenalectomy* ; Carcinoma, Renal Cell ; Conversion to Open Surgery ; Cushing Syndrome ; Hemorrhage ; Humans ; Hyperaldosteronism ; Intra-Abdominal Fat ; Laparoscopy ; Length of Stay ; Myelolipoma ; Operative Time ; Pathology ; Pheochromocytoma ; Teratoma ; Walking

The diagnosis of dilated cardiomyopathy associated with pheochromocytoma was made in a 24 year old male on the basis of symptoms and signs, measurements of metabolites of catecholamine,echocardiography and radionuclide ventriculography were preformed and demonstrated. The presence of a tumor on both adrenal glands without definite distant metastasis was demonstrated by abdominal ultrasonography, CT scanning and 131I-MIBC scintigraphy. Surgical removal was performed after proper preoperative preparation with a-adrenergic blocker. During the surgery, neither significant arrhythmia nor severe change of blood pressure was observed. After surgery, cardiac function of the patient improved slowly and progressively.
Adrenal Glands ; Arrhythmias, Cardiac ; Blood Pressure ; Cardiomyopathy, Dilated* ; Diagnosis ; Humans ; Male ; Neoplasm Metastasis ; Pheochromocytoma* ; Radionuclide Imaging ; Radionuclide Ventriculography ; Thoracic Surgery ; Tomography, X-Ray Computed ; Ultrasonography ; Young Adult