Skip to main content
SpringerLink
Log in

Endoscopic adrenalectomy for pheochromocytoma: difference between the transperitoneal and retroperitoneal approaches in terms of the operative course

  • Original article
  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background

Due to the intraoperative catecholamine secretion with hemodynamic changes, a larger tumor size and marked neovascularization, as compared with other adrenal pathologies, endoscopic adrenalectomy for pheochromocytoma represents a particular challenge involving a more difficult and morbid procedure. The aim of this study was to identify the optimal surgical approach for endoscopic adrenalectomy in patients with pheochromocytoma.

Methods

Over a period of 10 years (February 1994 to June 2004), 38 consecutive patients underwent endoscopic adrenalectomy for pheochromocytoma. As three patients underwent a bilateral procedure, a total of 41 adrenalectomies were performed. The transperitoneal approach was carried out in 23 patients, whereas 18 patients underwent a retroperitoneal adrenalectomy by a single operative team. Perioperative parameters were prospectively followed.

Results

There was no conversion to the open procedure. Intraoperative hypertensive episodes occurred in 21 patients (55.3%) and were controlled by antihypertensive agents. In 11 patients (28.9%), blood pressure values rose to above 200 mmHg (>1 min). A comparison between the retroperitoneal and transperitoneal procedures did not show a significant difference between the maximum intraoperative systolic (p = 0.730) and diastolic (p = 0.663) blood pressure values although intraoperative blood pressure peaks were seen more frequently during retroperitoneal adrenalectomy. The operative time was shorter for the patients who had transperitoneal adrenalectomy than compared to for those who had retroperitoneal adrenalectomy, although the difference was not significant. The intraoperative blood loss, perioperative morbidity, and length of postoperative hospital stay did not differ significantly between the surgical techniques (p > 0.05).

Conclusion

After adequate preparation, endoscopic adrenalectomy may be performed in patients with pheochromocytoma via both the retroperitoneal and the transperitoneal approaches. The shorter operating time, less frequent intraoperative blood pressure peaks, and the better overview of the operating field recommend the transperitoneal approach with the patient placed in a lateral position as the preferred operative procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

Reference

  1. Berends FJ, Van Der Harst E, Giraudo G, Terkivatan T, Kazemier G, Braining HA, De Herder WW, Bonjer HJ (2002) Safe retroperitoneal endoscopic resection of pheochromocytomas. World J Surg 26: 527–531

    Article  PubMed  Google Scholar 

  2. Bonjer HJ, Lange JF, Kazemier G, De Herder WW, Steyerberg EW, Bruining HA (1997) Comparison of three techniques for adrenalectomy. Br J Surg 84: 679–683

    Article  PubMed  Google Scholar 

  3. Brant LM, Doherty GM, Norton JA, Soper NJ, Quasebarth MA, Moley JF (1996) Laparoscopic adrenalectomy compared to open adrenalectomy for benign adrenal neoplasms. J Am Coll Surg 183: 1–10

    PubMed  Google Scholar 

  4. Chapuis Y, Sauvanet A, Pras-Jude N, Icard P (1992) Pheochromocytomes surrénaliens: apropos de 35 malade operes. J Chir (Paris) 129: 66–72

    Google Scholar 

  5. Fernández-Cruz L, Sáenz A, Benarroch G, Astudillo E, Taurá P, Sabater L (1996) Laparoscopic unilateral and bilateral adrenalectomy for Cushing’s syndrome: transperitoneal and retroperitoneal approaches. Ann Surg 224: 727–734

    Article  PubMed  Google Scholar 

  6. Fernández-Cruz L, Sáenz A, Benarroch G, Torres E, Astudillo E (1994) Technical aspects of adrenalectomy via operative laparoscopy. Surg Endosc 8: 1348–1351

    PubMed  Google Scholar 

  7. Fernández-Cruz L, Saenz A, Taurá P, Benarroch G, Astudillo E, Sabater L (1999) Retroperitoneal approach in laparoscopic adrenalectomy: is it advantageous? Surg Endosc 13: 86–90

    Article  PubMed  Google Scholar 

  8. Fernández-Cruz L, Sáenz A, Taurá P, Benarroch G, Nies C, Astudillo E (1994) Pheochromocytoma: laparoscopic approach with C02 and helium pneumoperitoneum. Endosc Surg Allied Technol 2: 300–304

    PubMed  Google Scholar 

  9. Gagner M, Breton G, Pharand D, Pomp A (1996) Is laparoscopic adrenalectomy indicated for pheochromocytomas? Surgery 120: 1076–1080

    PubMed  Google Scholar 

  10. Guz BV, Straffon RA, Novick AC (1989) Operative approaches to the adrenal gland. Urol Clin North Am 16: 527–534

    PubMed  Google Scholar 

  11. Heintz A, Junginger T, Böttger T (1995) Retroperitoneal endoscopic adrenalectomy. Br J Surg 82: 215

    PubMed  Google Scholar 

  12. Heintz A, Strecker U, Walgenbach S, Junginger Th (1997) Ergebnisse der endoskopischen, retroperitonealen Adrenalektomie unter besonderer Berücksichtigung des intraoperativen Verlaufs. Chirurg 68: 154–158

    Article  PubMed  Google Scholar 

  13. Irvin GL, Fishman LM, Sher JA, Yeung LK, Irani H (1989) Pheochromocytoma: lateral versus anterior operative approach. Ann Surg 209: 774–778

    PubMed  Google Scholar 

  14. Janetschek G, Finkenstedt G, Gasser R, Waibel UG, Peschel R, Bartsch G, Neumann HP (1998) Laparoscopic surgery for pheochromocytoma: adrenalectomy, partial resection, excision of paragangliomas. J Urol 160: 330–334

    Article  PubMed  Google Scholar 

  15. Kalady MF, McKinlay R, Olson JA Jr., Pinheiro J, Lagoo S, Park A, Eubanks WS (2004) Laparoscopic adrenalectomy for pheochromocytoma: a comparison to aldosteroma and incidentaloma. Surg Endosc 18: 621–625

    Article  PubMed  Google Scholar 

  16. Kim AW, Quiros RM, Maxhimer JB, El-Ganzouri AR, Prinz RA (2004) Outcome of laparoscopic adrenalectomy for pheochromocytomas vs aldosteromas. Arch Surg 139: 526–531

    Article  PubMed  Google Scholar 

  17. Kneist W, Vetter G, Kann P, Jaursch-Hancke, Heintz A, Hommel G. Junginger Th (2004) Transperitoneale oder retroperitoneale Adrenalektomie: Ergebnisse einer prospektiven Verlaufsbeobachtung. Chirurg in press

    Google Scholar 

  18. Lezoche E, Guerrieri M, Feliciotti F, Paganini AM, Perretta S, Baldarelli M, Bonjer J, Miccoli P (2002) Anterior, lateral, and posterior retroperitoneal approaches in endoscopic adrenalectomy. Surg Endosc 16: 96–99

    Article  PubMed  Google Scholar 

  19. Manger T, Piatek S, Klose S, Kopf D, Kunz D, Lehnert H, Lippert H (1997) Bilaterale laparoskopische transperitoneale Adrenalektomie beim Phäochromozytom. Langenbecks Arch Chir 3 82: 37–42

    Article  Google Scholar 

  20. Mann C, Millat B, Boccara G, Atger J, Colson P (1996) Tolerance of laparoscopy for resection of pheochromocytoma. Br J Anaesth 77: 795–797

    PubMed  Google Scholar 

  21. Meurisse M, Joris J, Hamoir E, Hubert B, Charlier C (1995) Laparoscopic removal of pheochromocytoma: why? when? and who? (reflection on one case report). Surg Endosc 9: 431–436

    Article  PubMed  Google Scholar 

  22. Mobius E, Nies C, Rothmund M (1999) Surgical treatment of pheochromocytomas: laparoscopic or conventional? Surg Endosc 13: 35–39

    Article  PubMed  Google Scholar 

  23. Orchard T, Grant CS, van Heerden JA, Weaver A (1993) Pheochromocytoma: continuing evolution of surgical therapy. Surgery 114: 1153–1159

    PubMed  Google Scholar 

  24. Thompson GB, Grant CS, van Heerden JA, Schlinkert RT, Young WF, Parley DR, Ilstrup DM (1997) Laparoscopic versus open posterior adrenalectomy: a case–control study of 100 patients. Surgery 122: 1132–1136

    Article  PubMed  Google Scholar 

  25. Walz MK, Peitgen K, Neumann HPH, Janssen OE, Philipp T, Mann K (2002) Endoscopic treatment of solitary, bilateral, multiple, and recurrent pheochromocytomas and paragangliomas. World J Surg 26: 1005–1012

    Article  PubMed  Google Scholar 

  26. Winfield HN, Hamilton BD, Blavo EL, Novick AC (1998) Laparoscopic adrenalectomy: the preferred choice? A comparison to open adrenalectomy. J Urol 160: 325–329

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General and Abdominal Surgery, Johannes Gutenberg University, Langenbeckstrasse 1, Mainz, D-55101, Germany

    I. Gockel, G. Vetter, A. Heintz & Th. Junginger

Authors
  1. I. Gockel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Vetter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Heintz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Th. Junginger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to I. Gockel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gockel, I., Vetter, G., Heintz, A. et al. Endoscopic adrenalectomy for pheochromocytoma: difference between the transperitoneal and retroperitoneal approaches in terms of the operative course. Surg Endosc 19, 1086–1092 (2005). https://doi.org/10.1007/s00464-004-2141-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-004-2141-3

Keywords

Search

Navigation