Indications And Contraindications

Indications of Laparoscopic Partial Adrenalectomy

Phaeochromocytoma-hereditary von Hippel-Lindau, multiple endocrine neoplasia

■ Adrenal adenoma

■ Aldosterone-producing adenoma-bilateral or unilateral

■ Cushing's adenoma

Contraindications of Laparoscopic Partial Adrenalectomy

Aldosteroma-concentric lesions, multiple ipsilateral tumors

■ Adrenal carcinoma (or clinical suspicion, i.e., incidentaloma)

■ Malignant pheochromocytoma

■ Uncorrected coagulopathy

Technically, a solitary, peripheral adrenal lesion located at some distance from the main adrenal vein is preferable for partial adrenalectomy. laparoscopic partial adrena-lectomy must be avoided in multiple aldosterone-producing adenomas, although laparoscopic partial adrenalectomy in the presence of two pheochromocytomas in the same adrenal gland has been reported (10).

The main adrenal vein may be sacrificed if needed, although every effort to preserve it should be made.

Main adrenal vein ligation does not compromise the postoperative function. However, adrenal functional recovery could be delayed in patients with pheochromo-cytoma, and temporary adrenal replacement may be needed. Previous abdominal surgery and morbid obesity are not absolute contraindications but may necessitate consideration of the retroperitoneal laparoscopic approach.

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