Subscribe to RSS
DOI: 10.1055/s-2003-38559
Laparoskopische Nebennierenexstirpation
Laparoscopic AdreanalectomyPublication History
Publication Date:
11 April 2003 (online)
![](https://www.thieme-connect.de/media/viszeralchirurgie/200302/lookinside/thumbnails/10.1055-s-2003-38559-1.jpg)
Zusammenfassung
Bei ausreichender chirurgischer Erfahrung kann die endoskopische Adrenalektomie (EA) mit geringem Blutverlust, niedriger Umstiegsrate und geringen Komplikationen eingesetzt werden. Immerhin 6 neuere Untersuchungen mit jeweils mindestens 100 Eingriffen zeigen einheitliche und durchweg positive Ergebnisse, was auch den eigenen Erfahrungen mit der EA entspricht. Die Konversionsraten (3 - 5 %) ebenso wie die Morbiditätsraten (8 - 18 %) sind niedrig, die Mortalität ist mit < 1 % sehr gering. Die EA ist den herkömmlichen Verfahren hinsichtlich der bekannten Vorteile der minimalinvasiven Chirurgie deutlich überlegen. Trotz fehlender kontrollierter Untersuchung gilt die EA mittlerweile bei nicht malignen adrenalen Tumoren < 5 - 7 cm als Verfahren der Wahl. Die EA kann transperitonel laparoskopisch (TEA) oder retroperitoneal (REA, von posterior oder lateral) durchgeführt werden, eine vergleichende Bewertung fällt wie in der offenen Chirurgie schwer. Obwohl mit der TEA die größeren Erfahrungen vorliegen, zeichnet sich ein Punktvorteil für die REA ab. Hier spielen abdominelle Voroperationen keine Rolle, intraabdominelle Organe müssen nicht mobilisiert oder zur Seite gehalten werden. Andererseits ist die anatomische Orientierung schwieriger. Speziell für adipöse Patienten scheint die REA besser geeignet. Die bisher selten praktizierte partielle Adrenalektomie wird in endoskopischer Technik zunehmend beliebter, Benefit und Indikationen müssen in weiteren Untersuchungen noch präzisiert werden.
Abstract
With increasing surgical experience, endoscopic adrenalectomy (EA) is performed with minimal blood loss, low conversion rate to open surgery and minimal complications. The outcome of 6 recently published studies each including > 100 patients was well balanced and generally positive, well in accordance with our own experience with EA. Conversion rate was 3 - 5 %, morbidity 8 - 18 % and mortality was very low (< 1 %). Displaying all of the common advantages of minimally invasive surgery, EA is clearly superior to conventional procedures. Despite a lack of controlled studies, EA has become the procedure of choice for benign adrenal tumors < 5 - 7 cm. EA may be performed by a transperitoneal laparoscopic (TEA) or by a retroperitoneal (REA, posterior or lateral) approach; as in open surgery possible advantages of one or the other are difficult to evaluate. There is a lot of experience with TEA, but REA seams to have slight advantages. With REA prior abdominal surgery is negligible, there is no need to dissect or retract intraperitoneal structures. In contrast anatomical orientation may be more difficult. REA seems to be the better option in obese patients. With EA, partial adrenalectomy is more frequently used, further studies are needed to evaluate benefit and indications.
Schlüsselwörter
Laparoskopische Adrenalektomie - minimalinvasive Chirurgie - Übersicht
Key words
Laparoscopic adrenalectomy - minimally invasive surgery - review
Literatur
- 1 Gagner M, Lacroix A, Bolte E. Laparoscopic adrenalectomy in Cushing's syndrome and pheochromocytoma. N Engl J Med. 1992; 327 1033
- 2 Lepsien G, Neufang T, Lüdtke F E. Laparoscopic resection of pheochromocytoma. Surg Endosc. 1994; 8 906-909
- 3 Heintz A, Junginger T, Böttger T. Retroperitoneal endoscopic adrenalectomy. Br J Surg. 1995; 82 215
- 4 Walz M K, Peitgen K, Krause U, Eigler F W. Die dorsale retroperitoneoskopische Adrenalektomie: eine neue operative Methode. Zentralbl Chir. 1995; 120 53
- 5 Walz M K, Peitgen K, Walz M V. et al . Posterior retroperitoneoscopic adrenalectomy: lessons learned within five years. World J Surg. 2001; 25 (6) 728-734
- 6 Bonjer H J, Sorm V, Berends F J, Bruining H A. et al . Endoscopic retroperitoneal adrenalectomy: lessons learned from 111 consecutive cases. Ann Surg. 2000; 232 (6) 796-803
- 7 Gagner M, Pomp A, Heniford B T, Pharand D, Lacroix A. Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures. Ann Surg. 1997; 226 (3) 238-246
- 8 Henry J F, Defechereux T, Raffaelli M, Lubrano D, Gramatica L. Complications of laparoscopic adrenalectomy: results of 169 consecutive procedures. World J Surg. 2000; 24 (11) 1342-1346
- 9 Lezoche E, Guerrieri M, Paganini A M, Feliciotti F, Zenobi P, Antognini F, Mantero F. Laparoscopic adrenalectomy by the anterior transperitoneal approach: results of 108 operations in unselected cases. Surg Endosc. 2000; 14 (10) 920-925
- 10 Terachi T, Matsuda T, Terai A. et al . Transperitoneal laparoscopic adrenalectomy: experience in 100 patients. J Endourol. 1997; 11 (5) 361-365
- 11 Grundlagen der Chirurgie G 92. Beilage zu: Mitteilungen der Dt. Ges. f. Chirurgie Stuttgart; 2000 29 4
- 12 Henry J F, Sebag F, Iacobone M, Mirallie E. Results of laparoscopic adrenalectomy for large and potentially malignant tumors. World J Surg. 2002; 26 (8) 1043-1047
- 13 Brunt L M, Moley J F. Adrenal incidentaloma. World J Surg Review. 2001; 25 (7) 905-913
- 14 Linos D A, Stylopoulos N, Raptis S A. Adrenaloma: a call for more aggressive management. World J Surg. 1996; 20 (7) 788-792
- 15 Heniford B T, Arca M J, Walsh R M, Gill I S. Laparoscopic adrenalectomy for cancer. Semin Surg Oncol. 1999; 16 (4) 293-306
- 16 Kebebew E, Siperstein A E, Clark O H, Duh Q Y. Results of laparoscopic adrenalectomy for suspected and unsuspected malignant adrenal neoplasms. Arch Surg. 2002; 137 (8) 948-951
- 17 Aniszewski J P, Young W F, Thompson G B, Grant C S, van Heerden J A. Cushing syndrome due to ectopic adrenocorticotropic hormone secretion. World J Surg. 2001; 25 (7) 934-940
- 18 Bax T W, Marcus D R, Galloway G Q, Swanstrom L L, Sheppard B C. Laparoscopic bilateral adrenalectomy following failed hypophysectomy. Surg Endosc. 1996; 10 (12) 1150-1153
- 19 Nagesser S K, van Seters A P, Kievit J, Hermans J, Krans H M, van de Velde C J. Long-term results of total adrenalectomy for Cushing's disease. World J Surg. 2000; 24 (1) 108-113
- 20 Fernandez-Cruz L, Saenz A, Benarroch G, Astudillo E, Taura P, Sabater L. Laparoscopic unilateral and bilateral adrenalectomy for Cushing's syndrome. Transperitoneal and retroperitoneal approaches. Ann Surg. 1996; 224 (6) 727-734
- 21 Walz M K, Peitgen K, Neumann H P, Janssen O E, Philipp T, Mann K. Endoscopic treatment of solitary, bilateral, multiple, and recurrent pheochromocytomas and paragangliomas. World J Surg. 2002; 26 (8) 1005-1012
- 22 Janetschek G, Finkenstedt G, Gasser R, Waibel U G, Peschel R, Bartsch G, Neumann H P. Laparoscopic surgery for pheochromocytoma: adrenalectomy, partial resection, excision of paragangliomas. J Urol. 1998; 160 (2) 330-334
- 23 Berends F J, Harst E V, Giraudo G. et al . Safe retroperitoneal endoscopic resection of pheochromocytomas. World J Surg. 2002; 26 (5) 527-531
- 24 Brunt L M, Lairmore T C, Doherty G M, Quasebarth M A, DeBenedetti M, Moley J F. Adrenalectomy for familial pheochromocytoma in the laparoscopic era. Ann Surg. 2002; 235 (5) 713-720
- 25 Cheah W K, Clark O H, Horn J K, Siperstein A E, Duh Q Y. Laparoscopic adrenalectomy for pheochromocytoma. World J Surg. 2002; 26 (8) 1048-1051
- 26 Kercher K W, Park A, Matthews B D, Rolband G, Sing R F, Heniford B T. Laparoscopic adrenalectomy for pheochromocytoma. Surg Endosc. 2002; 16 (1) 100-102
- 27 Mobius E, Nies C, Rothmund M. Surgical treatment of pheochromocytomas: laparoscopic or conventional?. Surg Endosc. 1999; 13 (1) 35-39
- 28 Jeschke K, Janetschek G, Peschel R, Schellander L, Bartsch G, Henning K. Laparoscopic partial adrenalectomy in patients with aldosterone-producing adenomas: indications, technique, and results. Urology. 2003; 61 (1) 69-72
- 29 Neumann H P, Bender B U, Reincke M, Eggstein S, Laubenberger J, Kirste G. Adrenal-sparing surgery for phaeochromocytoma. Br J Surg. 1999; 86 (1) 94-97
- 30 Walz M K, Peitgen K, Saller B. et al . Subtotal adrenalectomy by the posterior retroperitoneoscopic approach. World J Surg. 1998; 22 (6) 621-626
- 31 Suzuki K, Sugiyama T, Saisu K, Ushiyama T, Fujita K. Retroperitoneoscopic partial adrenalectomy for aldosterone-producing adenoma using an ultrasonically activated scalpel. Br J Urol. 1998; 82 (1) 138-139
- 32 Baghai M, Thompson G B, Young W F, Grant C S, Michels V V, van Heerden J A. Pheochromocytomas and paragangliomas in von Hippel-Lindau disease: a role for laparoscopic and cortical-sparing surgery. Arch Surg. 2002; 137 (6) 682-688
- 33 Kok K Y, Yapp S K. Laparoscopic adrenal-sparing surgery for primary hyperaldosteronism due to aldosterone-producing adenoma. Surg Endosc. 2002; 16 (1) 108-111
- 34 Trupka A, Hallfeldt K, Schmidbauer S. Laparoskopische Adrenalektomie in Seitenlage - ein Vergleich mit der konventionellen dorsalen Technik. Chirurg. 2001; 72 (12) 1478-1484
- 35 Smith C D, Weber C J, Amerson J R. Laparoscopic adrenalectomy: new gold standard. World J Surg. 1999; 23 (4) 389-396
- 36 Nies C, Mobius E, Rothmund M. Laparoskopische Nebennierenchirurgie. Chirurg. 1997; 68 (2) 99-106
- 37 Fernandez-Cruz L, Saenz A, Taura P, Benarroch G, Astudillo E, Sabater L. Retroperitoneal approach in laparoscopic adrenalectomy: is it advantageous?. Surg Endosc. 1999; 13 (1) 86-90
- 38 Nies C. Anatomie des Retroperitoneums aus Sicht der minimal-invasiven-Chiurgen. Chirurg. 1998; 69 597-603
- 39 Walz M K. Minimal-invasive Nebennierenchirurgie. Chirurg. 1998; 69 (6) 613-620
- 40 Valeri A, Borrelli A, Presenti L. et al . The influence of new technologies on laparoscopic adrenalectomy: our personal experience with 91 patients. Surg Endosc. 2002; 16 (9) 1274-1279
- 41 MacGillivray D C, Khwaja K, Shickman S J. Confluence of the right adrenal vein with the accessory right hepatic veins. A potential hazard in laparoscopic right adrenalectomy. Surg Endosc. 1996; 10 (11) 1095-1096
- 42 Corcione F, Esposito C, Cuccurullo D, Settembre A, Fusco F, Bianco A, Cusano T. Vena cava injury. A serious complication during laparoscopic right adrenalectomy. Surg Endosc. 2001; 15 (2) 218
- 43 Winfield H N, Hamilton B D, Bravo E L, Novick A C. Laparoscopic adrenalectomy: the preferred choice? A comparison to open adrenalectomy. J Urol. 1998; 160 (2) 325-329
- 44 Shen W T, Lim R C, Siperstein A E. et al . Laparoscopic vs open adrenalectomy for the treatment of primary hyperaldosteronism. Arch Surg. 1999; 134 (6) 628-631
- 45 Bonjer H J, van der Harst E, Steyerberg E W. et al . Retroperitoneal adrenalectomy: open or endoscopic?. World J Surg. 1998; 22 (12) 1246-1249
- 46 Dudley N E, Harrison B J. Comparison of open posterior versus transperitoneal laparoscopic adrenalectomy. Br J Surg. 1999; 86 (5) 656-660
- 47 Hazzan D, Shiloni E, Golijanin D, Jurim O, Gross D, Reissman P. Laparoscopic vs open adrenalectomy for benign adrenal neoplasm. Surg Endosc. 2001; 15 (11) 1356-1358
- 48 Hallfeldt K K, Mussack T, Trupka A, Hohenbleicher F, Schmidbauer S. Laparoscopic lateral adrenalectomy versus open posterior adrenalectomy for the treatment of benign adrenal tumors. Surg Endosc. 2002; 1 29
- 49 Thompson G B, Grant C S, van Heerden J A. et al . Laparoscopic versus open posterior adrenalectomy: a case-control study of 100 patients. Surgery. 1997; 122 (6) 1132-1136
- 50 Brunt L M. The positive impact of laparoscopic adrenalectomy on complications of adrenal surgery. Surg Endosc. 2002; 16 (2) 252-257
- 51 Thomusch O, Dralle H. Endokrine Chirurgie und Evidenz-basierte Medizin. Chirurg. 2000; 71 (6) 635-645
- 52 Lezoche E, Guerrieri M, Feliciotti F. et al . Anterior, lateral, and posterior retroperitoneal approaches in endoscopic adrenalectomy. Surg Endosc. 2002; 16 (1) 96-99
- 53 Berber E, Duh Q Y, Clark O H, Siperstein A E. A critical analysis of intraoperative time utilization in laparoscopic adrenalectomy. Surg Endosc. 2002; 16 (2) 258-262
Th. Neufang
Chirurgische Klinik, Universitätsklinikum Mannheim, Fakultät für klinische Medizin Mannheim der Universität Heidelberg, Mannheim
Theodor-Kutzer-Ufer 1 - 3
68127 Mannheim
Phone: 0621/3832225
Fax: 0621/3832166
Email: thomas.neufang@chir.ma.uni-heidelberg.de