V6-03: Synchronous and Simultaneous Posterior Reroperitoneoscopic Bilateral Adrenalectomy.
Laparoscopic bilateral adrenalectomy is a challenging procedure that usually requires patient repositioning and long operative time. Posterior retroperitoneoscopic adrenalectomy, by providing direct access to the gland, allows two surgical teams to work together, avoiding patient repositioning. This is an interesting approach in patients with bilateral affection. _x000D_ We describe the technique of synchronous and simultaneous posterior retroperitoneoscopic bilateral adrenalectomy in a patient with neurofibromatosis syndrome type 1 and bilateral pheocromocytomas.
A 25-year-old man with neurofibromatosis syndrome type 1 and past medical history of kidney transplant was referred for a 1 year long severe refractory hypertension. A thorough evaluation was performed for possible secondary causes of hypertension. Clinical suspicion of pheochromocytoma was confirmed by 24 hour urinary catecholamines level and CT scan of abdomen. The CT scan showed right sided adrenal mass of 45 mm and left adrenal mass of 43 mm. With patient placed in prone position, using 3 trocars per side and with two surgical teams working simultaneously a posterior retroperitoneoscopic bilateral total adrenalectomy was performed.
The operation time was 120 minutes, intraoperative blood loss was 300 ml. With no postoperative complications, the patient had a fast postoperative recovery and was discharged on the third postoperative day. Blood pressure became normal from 1st post operative day without any drug. Differed histopathology exam confirmed that both adrenal tumors were pheochromocytomas. There was no clinical or biochemical relapse during a follow up period of 6 months.
Synchronous and Simultaneous Posterior Retroperitoneoscopic Bilateral Adrenalectomy is a safe and feasible technique in patients with bilateral pheochromocytomas.