Laparoscopic Ultrasound

We used laparoscopic ultrasonography in 15 selected cases. In 1 patient it showed the location of a 0.7-cm aldosteronoma in an adrenal gland after open surgery failed to find the organ. In 2 patients, no adenoma was found, necessitating only biopsy and closure rather than adrenalectomy. In 2 patients with large masses (10 and 12 cm), no extra-adrenal or lymph node involvement was found. The masses were completely removed laparoscopically and proved to be histologically benign. In 1 patient, vascular invasion of an adrenal adenocarcinoma was found, leading to conversion to successful open resection. In 1 patient with metastatic cancer, the invasion of periadrenal fat was demonstrated, and the lesion was removed with negative margins. In an additional 2 cases, it helped identify the right adrenal vein, which facilitated dissection and control. Finally, bilateral hyperplasia was found in another case, requiring bilateral adrenalectomy.

Other groups reported similar results using laparoscopic ultrasonography in adrenalectomy.73,74 Brunt and associates74 used it in 27 patients and concluded that laparoscopic ultrasound provided useful information to the surgeon in 11 of 28 procedures (39%) by (1) localizing the adrenal gland and tumor and/or guiding the dissection, (2) demonstrating that tumors larger than 4 cm were confined to the gland, and (3) investigating suspected pathology in other organs. Mean time for ultrasound was 10.9 minutes, and calculated hospital charges were $602. There were no intraoperative complications. Siperstein and colleagues75 found that it helped in identifying small tumors in obese patients operated on through the posterior approach. Especially in patients with nodular hyperplasia, laparoscopic ultrasound enabled the complete excision of all lesions by demonstrating the absence or presence of residual tumor tissue in the adrenal bed after resection.75 Thus, the information obtained from ultrasonography in many instances can affect the progression of the operation. It is a simple technique that can be easily mastered.

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