V4-13: Left-sided laparoscopic partial adrenalectomy for pheochromocytoma

Video

Introductions and Objectives
Laparoscopic partial adrenalectomy or adrenal sparing surgery originated from the aim of preserving functioning gland in order to obviate the need for hormonal replacement and undesired side effects. A case of left-sided laparoscopic partial adrenalectomy for phechromocytoma and technical aspects are presented in this video.

Methods
A 54 year old female patient was referred to our hospital with a 4 cm left adrenal mass in ultrasonographic examination. She has been on medication for HT for 2 years and she was complaining of flushing and palpitation. Endocrinologic work-up consisted of plasma thyroid hormone levels, plasma catecholamine and basal cortisol levels, ACTH supression test, 24-hour urinary measurement of cortizol and catecholamines. She underwent PET-CT imaging for radiologic diagnosis. She was prescribed alpha-blocker therapy 1-month before surgery and left-sided laparoscopic partial adrenalectomy with lateral transperitoneal approach using 3 entry ports was performed. Intraoperative laparoscopic color doppler ultrasonography confirmed the viability and vascular supply of the remaining adrenal gland.

Results
Thyroid hormone levels and plasma catecholamine and basal cortisol levels were in normal ranges and ACTH suppression test was negative. 24-hour urinary measurement of homovanillic acid ( HVA ) level was slightly higher than normal levels with 10.73 mg/24h ( Reference ranges : 0.5-6.2 mg/24h ) whereas vanillylmandelic acide (VMA), metanephrine and normetanephrine levels were in normal ranges. PET-CT imaging supported the diagnosis of pheochromocytoma. Operation was performed under general anesthesia and the operation time was 45 minutes. No peroperative or postoperative complication was encountered and the patient was discharged one day after the surgery. Pathologic examination revealed pheochromocytoma.

Conclusions
Laparoscopic partial adrenalectomy might be attempted for excision of pheochromocytoma whenever feasible.

Funding: None