CU 16. Retroperitoneoscopic surgery for adrenal lesions close to vena cava in 138 Patients

Objective: To summarize our experiences in the retroperitoneoscopic adrenalectomy (RPA) for adrenal lesions close to vena cava.

Methods: We retrospectively analyzed the clinical data of 1278 consecutive patients who had undergone RPA from September 2005 to October 2011, among whom 138 had adrenal tumors close to vena cava. All the lesions were located in the right side. During surgery, the internal part of the adrenal gland closing to the retroperitoneum was liberated firstly, and the whole adrenal gland was dissected along the inferior vena cava completely.

Results: Mortality was zero. There were no obvious perioperative complications except 4 cases of perforation of the retroperitoneum intraoperatively in the case of pheochromocytoma. Adrenal tumors averaged 3.6 cm (range, 1.2-6.5 cm), including 90 cases of primary hyperaldosteronism (80 adenomas and10 Hyperplasia), 20 nonfunctional adrenal adenomas, 10 Pheochromocytoma, and 8 Cushing's syndrome. The mean operative time was 75 min (35-145 min), mean estimated blood loss 100 mL (50-250 mL), and mean postoperative hospital stay 4 d (3-7 d). Follow-up (5 -38 months) showed no recurrence.

Conclusions: CT angiography or MR angiography should be performed preoperatively to evaluate the whole blood supply of the adrenal tumor. If local invasion is detected by the preoperative imaging, laparoscopic treatment is no longer a preferred option. The adrenal tissue close to vena cava must be dissected with extreme care, and a laparoscopic vascular clamp must be ready for emergency lateral clamping of the vena cava, and also prepare sufficiently in case of the conversion to open surgery.