Adrenal Surgery; History of Evolution, Treatment and Advantages

 

Laparoscopic Trainer

Laparoscopic Trainer

History of Adrenal Surgery

The dramatic and complex history of adrenal surgery reflects the unique structure of the adrenal glands and the versatility of their pathological conditions. For the first time successfully removed the adrenal gland with a tumor. The surgeon performs the first successful adrenalectomy for pheochromocytoma.

Use of Laparoscopic Trainer is a prudent choice for Training.

It presents a systematic review of the scientific literature on the role of minimally invasive interventions in the surgical treatment of patients with adrenal tumors. Particular attention pays to the existing ideas about the indications and contraindications for their use. The analysis of complications of endoscopic operations carries out; ways of their prevention discusses.

Treatment

The role of X-ray endovascular methods, in particular preoperative embolization, in the complex treatment of patients with adrenal pathology is also touched. It dedicates to the role of minimally invasive interventions in the surgical treatment of patients with adrenal tumors. The analysis of complications of endoscopic operations carries out; ways of their prevention discusses. The role of X-ray endovascular methods, in particular preoperative embolization, in the complex treatment of patients with adrenal pathology is also touched. Particular attention pays to the existing ideas about the indications and contraindications for their use. The analysis of complications of endoscopic operations carries out; ways of their prevention discusses. The role of X-ray endovascular methods, in particular preoperative embolization, in the complex treatment of patients with adrenal pathology is also touched.

In the same year, repeated the success of his colleague by removing a pheochromocytoma in a patient who suffered from paroxysms of arterial hypertension. The surgeon presents the results of surgical treatment of patients with Cushing's syndrome. They were disappointing, with a mortality rate of 30%. This reflected an insufficient understanding of the physiology of the adrenal glands and the pathophysiology of their diseases, the absence of a well-formed concept of replacement therapy.

Results of Treatment

Only by the middle of the last century, advances in physiology, biochemistry and pharmacology led to the formation of the concept of replacement therapy, the emergence of synthetic hormones, adrenolytic drugs. This radically changed the results of treatment, thus marking the beginning of a qualitatively new stage in development.

In 1949 published the results of 29 adrenalectomies for Cushing's syndrome, in the last nine cases hormone replacement therapy with cortisone performs. 30% mortality in the first group and its absence in the second testify to the effectiveness of substitution therapy. In 1956, they also presented the results of surgical treatment of 51 patients with pheochromocytoma. By 1951, 151 cases of pheochromocytoma resection publish in the literature with a mortality rate of 26%. Due to the use of adrenolytic therapy, there was no lethality in this series. Further development was associated with the improvement of laboratory and instrumental diagnostic methods.

The Evolution of Adrenal Surgery

The countdown of a new era in adrenal surgery has been going on since 1992, when published data on the first laparoscopic adrenalectomies. The results obtained reflected the classic advantages of minimally invasive surgery: less trauma, reduced pain, low intraoperative blood loss, accelerated rehabilitation, and shorter hospital stay. In 1997, the authors of the original technique presented the experience of 100 laparoscopic adrenalectomies, demonstrating a wide range of application of the method and good immediate and long-term results. Along with the wide distribution of the original method, the technology of retro-peritoneoscopic adrenalectomy was developed, the results of which first publishes in 1995.

Advantages of Minimally Invasive Technologies

Endovideosurgical adrenalectomy is currently the gold standard in the treatment of patients with adrenal tumors. The advantages of this method in relation to traditional surgery demonstrate are in numerous studies. In 2004, published a meta-analysis of 20 studies comparing minimally invasive and open adrenal surgery. All included studies demonstrated the undoubted advantages of minimally invasive technologies in terms of the intensity of postoperative pain syndrome, the volume of intraoperative blood loss, the frequency of complications and the duration of hospitalization.

Conclusion

The Surgeon  report a 54% incidence of incision-associated complications in open adrenalectomy, such as weakness of the lateral muscles of the abdominal wall in 30%, chronic pain in 14%, paresthesia in 10% of cases. Similarly, report late access-related complication rates as high as 48% with conventional interventions. Such complications can qualitatively affect the standard of living of patients, require repeated surgical interventions, and are economically disadvantageous.

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