V11-04: BILATERAL LAPAROSCOPIC ADRENAL TUMOR RESECTION
Since the first laparoscopic adrenalectomy described by Gagner et al in 1992, it has become the approach of election, been safe and effective. Castillo et al presented by first time in the Spanish literature a serial cases of primary aldosteronism caused by adenomas where he performed partial laparoscopic resections with favorable conclusions.
This is a case of a 44 years old male with secondary hypertension caused by primary aldosteronism by bilateral adrenal masses (Conn Syndrome) 19 mm right y 23 mm left side. Without achieving medical control of hypertension, the resection of both adrenal masses was decided, after laterality functional studies went no conclusive, to be performed in a single procedure.
A transperitoneal approach is performed. We started with the right side: the patient is positioned in the left lateral flank position. Pneumoperitoneum using open technique, opening of the retroperitoneal space , identification and dissection of the adrenal gland, identification, dissection and resection of right adrenal tumor. Hemostasis with the bipolar grasper. The patient is re-positioned in the right lateral flank position. Pneumoperitoneum using open technique. The line of Toldt is incised and the colon retracted medially, the spleen and tail of pancreas are also mobilized cephalad and medially, identification of the adrenal tumor in the anterior inner edge of the gland and the enucleation of adrenal adenoma is performed_x000D_ The Operative time was 190 minutes with minimal bleeding. The patient was discharge in the 3rd postoperative day without any incidents. Less requirement of anti-hypertensive drugs since the postoperative time was reported. The pathology reported bilateral adrenal adenomas 3.5cm left and right 2.5cm side._x000D_ The tests one month after surgery showed normal potassium. The hypertension was controlled with fewer drugs, without requirement of corticosteroid therapy. _x000D_ In our center we have performed in the last 10 years 38 laparoscopic adrenalectomy, 27 with benign results, been our most frequently found pheochromocytoma.
The laparoscopic adrenal tumor resection (partial adrenalectomy or enucleation) could be considered the procedure of choice in cases of accessible tumors with bilateral tumors or single gland. This is our first case of laparoscopic bilateral adrenal tumor resection in one surgical time. The procedure coursed without complications and favorable clinic results.