World Journal of Endocrine Surgery

Register      Login

VOLUME 9 , ISSUE 1 ( January-April, 2017 ) > List of Articles

CASE REPORT

Salvage Technique for Intraoperative Hemorrhage during Laparoscopic Resection of Large Pheochromocytoma: A Case Report and Literature Review

Reyaz M Singaporewalla, Daniel JK Lee, Yen P Tan

Citation Information : Singaporewalla RM, Lee DJ, Tan YP. Salvage Technique for Intraoperative Hemorrhage during Laparoscopic Resection of Large Pheochromocytoma: A Case Report and Literature Review. World J Endoc Surg 2017; 9 (1):27-31.

DOI: 10.5005/jp-journals-10002-1204

Published Online: 01-04-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim

We described the use of a hand-port assisted laparoscopic adrenalectomy for excising a large 10 cm vascular left adrenal pheochromocytoma. The useful technical tips and important pitfalls to avoid for a successful outcome are discussed in this article.

Introduction

A 64-year-old man who was investigated for microalbuminuria was found to have a 10-cm left adrenal mass. Blood investigation and imaging confirmed it to be a pheochromocytoma.

Case report

Initial mobilization of the adrenal mass was performed laparoscopically using two 5-mm ports in the epigastric. While dissecting the inferomedial pedicle, the aberrant adrenal vessel was injured and resulted in torrential bleeding. A gelport for hand assistance was inserted as a salvage approach for hemostasis.

Conclusion

Hand-port assisted laparoscopic adrenalectomy is a very practical and easy-to-adopt technique that preserves the minimally invasive surgical advantages in patients with large adrenal masses.

Clinical significance: We advocate the use of hand-assisted laparoscopic adrenalectomy technique for complex pheochromocytoma as an alternative for surgeons with vast experience in laparoscopic adrenalectomy.

How to cite this article

Lee DJK, Tan YP, Singaporewalla RM. Salvage Technique for Intraoperative Hemorrhage during Laparoscopic Resection of Large Pheochromocytoma: A Case Report and Literature Review. World J Endoc Surg 2017;9(1):27-31.


PDF Share
  1. Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures. Ann Surg 1997 Sep;226(3):238-246.
  2. Laparoscopic lateral adrenalectomy versus open posterior adrenalectomy for the treatment of benign adrenal tumors. Surg Endosc 2003 Feb;17(2):264-267.
  3. Long-term outcomes of laparoscopic adrenalectomy for adrenal masses. J Laparoendosc Adv Surg Tech A 2015 Mar;25(3):182-186.
  4. Laparoscopic adrenalectomy for large pheochromocytoma. BJU Int 2007 Nov;100(5):1126-1129.
  5. Is laparoscopic adrenalectomy safe and effective for adrenal masses larger than 7 cm? Surg Endosc 2008 Feb;22(2):516-521.
  6. Laparoscopic resection of large adrenal tumors. JSLS 2010 Jul-Sep;14(3):364-368.
  7. Reasons for conversion from laparoscopic to open or hand-assisted adrenalectomy: review of 261 laparoscopic adrenalectomies from 1993 to 2003. World J Surg 2004 Nov;28(11):1176-1179.
  8. Laparoscopic adrenalectomy for adrenal masses: does size matter? Urology 2008 Jun;71(6):1138-1141.
  9. The role of laparoscopic adrenalectomy for adrenal tumours of 6 cm or greater. Surg Endosc 2008 Mar;22(3):617-621.
  10. Tolerance of laparoscopy for resection of phaeochromocytoma. Br J Anaesth 1996 Dec;77(6):795-797.
  11. Laparoscopic surgery for pheochromocytoma. Urol Clin North Am 2001 Feb;28(1):97-105.
  12. Helium and carbon dioxide pneumoperitoneum in patients with pheochromocytoma undergoing laparoscopic adrenalectomy. World J Surg 1998 Dec;22(12):1250-1255.
  13. Laparoscopic adrenalectomy in Cushings syndrome and pheochromocytoma. N Engl J Med 1992 Oct 1;327(14):1033.
  14. Pheochromocytoma does not increase risk in laparoscopic adrenalectomy. Surg Endosc 2010 Nov;24(11):2760-2764.
  15. Hemodynamic changes and catecholamine release during laparoscopic adrenalectomy for pheochromocytoma. Anesth Analg 1999 Jan;88(1):16-21.
  16. Realtime heart rate variability and its correlation with plasma catecholamines during laparoscopic adrenal pheochromocytoma surgery. Anesth Analg 2008 Jan;106(1):164-170.
  17. Preoperative management of the pheochromocytoma patient. J Clin Endocrinol Metab 2007 Nov;92(11):4069-4079.
  18. Preoperative pharmacological management of phaeochromocytoma. Neth J Med 2006 Sep;64(8):290-295.
  19. Risk factors affecting operative approach, conversion, and morbidity for adrenalectomy: a single-institution series of 402 patients. Surg Endosc 2013 Jul;27(7):2342-2350.
  20. Results of laparoscopic adrenalectomy for suspected and unsuspected malignant adrenal neoplasms. Arch Surg 2002 Aug;137(8):948-951.
  21. Arterial embolization of adrenal tumors: results in nine cases. AJR Am J Roentgenol 1988 Oct;151(4):819-822.
  22. Laparoscopic adrenalectomy for pheochromocytoma. A comparison to aldosteronoma and incidentaloma. Surg Endosc 2004 Apr;18(4):621-625.
  23. Should laparoscopic approach be proposed for large and/or potentially malignant adrenal tumors? Langenbeck Arch Surg 1999 Aug;384(4):366-369.
  24. Laparoscopic adrenalectomy for large-volume (≥5 cm) adrenal masses. J Endourol 2000 Mar;14(2):149-154.
  25. Retroperitoneoscopic or laparoscopic adrenalectomy? A single-centre UK experience. Surg Endosc 2013 Nov;27(11):4147-4152.
  26. Adrenalectomy: a retroperitoneal procedure. BJU Int 2016 May;117(5):718-719.
  27. Hand assisted laparoscopic adrenalectomy: an alternative minimal invasive surgical technique for the adrenal gland. ANZ J Surg 2002 Nov;72(11):801-805.
  28. Laparoscopic adrenalectomy for large adrenal masses: single team experience. Int J Surg 2014 Aug;12 (Supp 1):S72-74.
  29. Effectiveness and safety of laparoscopic adrenalectomy of large pheochromocytoma: a prospective, nonrandomized, controlled study. Am J Surg 2015 Aug;210(2):230-235.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.