AB154. Effect of early adrenal vein ligation on blood pressure and catecholamine fluctuation during laparoscopic adrenalectomy for pheochromocytoma

Objective: To find out whether previous control of the adrenal vein is a crucial procedure in laparoscopic adrenalectomy for pheochromocytoma.

Method: From January 2000 to December 2010, 114 pheochromocytoma patients underwent laparoscopic adrenalectomy through transperitoneal or retroperitoneal approach. All the 114 patients were divided into two groups randomly (group 1, dissection after ligation; group 2, dissection before ligation). Blood samples to dose catecholamines using high performance liquid chromatography were carried out at the following times: t1: test just before anesthesia; t2: during manipulation-extraction of pheochromocytoma; t3: after removal of pheochromocytoma. The blood pressure fluctuation was recorded.

Results: Laparoscopic adrenalectomy was successfully performed in 113 cases with 1 elective open conversion because of dense peritumor adhesions. The operating time ranged from 80 to 150 minutes (mean 108, 102 in group 1, 110 in group 2). Mean blood loss ranged from 20 to 500 mL (mean 120 mL, 110 in group 1, 125 in group 2). The dosages of plasma catecholamines between the two groups had no statistical disparity. The blood pressure fluctuation incidence between the two groups had no marked difference. But the incidence increased with high functionary grade, and the difference was significant (P=0.043).

Conclusions: This study demonstrated that previous control of the adrenal vein was not a determinate factor in dealing with dangerous hypertension during laparoscopic adrenalectomies.

Keywords: Early adrenal vein ligation; blood pressure; catecholamine fluctuation; laparoscopic adrenalectomy