La surrenectomia retroperitoneoscopica posteriore: casistica personale

[Autom. eng. transl.] Foreword Endoscopic adrenalectomy is the gold standard of treatment of small and medium-sized benign adrenal lesions, both functional and non-functional. In the field of endoscopic adrenalectomy techniques, the posterior retroperitoneoscopic approach represents a direct approach to the adrenal glands that potentially offers some advantages over other endoscopic accesses. Aim of the study The aim of this work is to report our experience of endoscopic adrenalectomy with posterior retroperitoneoscopic approach (Posterior Retroperitoneoscopic Adrenalectomy - PRA). Methods From July 2003 to December 2009, 93 PRAs were performed at the General and Endocrine Surgery Unit of the A. Gemelli General Hospital in Rome, out of a total of 383 adrenalectomies (48 right-handed, 39 left and 6 bilateral simultaneous for syndrome of Cushing). The indication for surgery was an adrenal hypersecretion in 76 patients and an incidentaloma in 17 patients. Previous abdominal surgery procedures were recorded in 37 patients (39.8%). Results The mean operative time was 115.5 ± 50.5 minutes (range: 50-285). The open conversion was necessary in 2 cases (2.1%). In 2 cases intra-operative bleeding from a caval lesion occurred, resolved endoscopically. Minor post-operative complications were reported in 2.1% of cases. The average diameter of the lesions was 30.5 ± 13.7 mm (range: 10-70) and the definitive histological examination documented 66 adrenal adenomas, 16 pheochromocytomas of which 2 were malignant, 1 cortico-adrenal carcinoma, 3 metastases , 6 bilateral adrenal hyperplasia and 1 myelolipoma. The mean post-operative stay was 4.1 ± 1.5 days (range: 3-11). At a median follow-up of 34.8 ± 21.7 months (range: 2-82), recurrent disease was documented in none of the PRA patients. One exception is one of 6 patients with Cushing's syndrome who, at a mean follow-up of 25.0 ± 10.0 months (range: 12-40), died of the primary disease (metastatic breast cancer) about 10 months after the surgery. Conclusions PRA represents a safe and effective approach in the treatment of benign adrenal lesions with a diameter ≤ 6 cm, ideal in cases where bilateral adrenalectomy is indicated and in patients who have already undergone major abdominal surgery.