Postoperative Complications and Advantages of Endo-Video-Surgery in Adrenalectomy

 

Recommendations in Endo-Video-Surgical Technologies

Summarizing the discussion of the field of application of minimally invasive technologies in surgery for adrenal tumors, we can come to the following. Despite the numerous existing positions and the inconsistency of recommendations, it seems that Endo-Video-Surgical technologies have a number of limitations. These limitations best characterizes not by the categories of feasibility or impracticability of laparoscopic operations under certain circumstances, but by efficiency and safety.

Use of Simulations is significant choice with Lap Trainer Box.

In proportion to the increase in the size of the removed formations, the effectiveness and safety of the method decreases, which reflects in the volume of blood loss, the frequency of conversions and complications. The probability of damage to the tumor capsule increases, which compromises the oncological results. However, the undeniable advantages of minimally invasive surgery require solutions to finds.

Postoperative Complications

Increasing practical importance demonstrates by X-ray endovascular methods, in particular, vascular embolization. The method of preoperative embolization has earned a particularly active discussion in the literature. Used in most cases for tumors of various localization, according to the results of many studies, it can improve the performance of surgical treatment. Reducing intraoperative blood loss, the volume of donor blood transfusion and, as a result, the number of intra- and postoperative complications are, according to a number of experts, the advantages of preoperative embolization.

Little experience gains in the use of endovascular embolization in patients with adrenal tumors, but encouraging results obtains. The effectiveness of the method in reducing the volume and hormonal activity of the tumor, reducing the pain syndrome in patients with inoperable adrenal tumors was demonstrates.

Advantages of Minimally Invasive Surgery in Adrenalectomy

Similar effects demonstrate both in relation to the primary focus and in relation to metastases. This not only improves the quality of life, but can also have a positive impact on survival rates. It uses the method of transarterial embolization in patients with aldosteromas. In 83% of cases, they received a stable normalization of the hormonal profile. According to the authors, the need for the method may arise if the patient belongs to a high operational risk group or refuses surgery. The method has proven itself well for spontaneous ruptures of tumors of the adrenal glands with retroperitoneal hemorrhage. It avoids emergency adrenalectomy in adverse conditions.

Other rarer causes of adrenal hemorrhage are blunt abdominal trauma and ruptured adrenal aneurysms. The few publications on the use of adrenal artery embolization in these patients have also demonstrated its effectiveness.

Results

Few publications are devoted to the use of preoperative embolization in the treatment of patients with adrenal tumors. In 1988 published the results of Trans arterial embolization is performed in 9 patients. In only one case, it performs before adrenalectomy. In general, the use of X-ray endovascular embolization in this format covered in the literature by rare publications of clinical cases.

The surgeon reports the successful removal of a 13 cm adrenocortical carcinoma of the left adrenal gland after preliminary embolization. It according to the authors, contributed to the smooth course of the operation and the postoperative period. The greatest experience presents by who reported three cases of preoperative embolization.

Based on this experience, the authors concluded that preoperative embolization for a large hyper-vascular adrenal mass facilitates the operation by reducing intraoperative blood loss. In addition, it avoids catecholamine crises in patients with large pheochromocytomas. In general, when compared with other areas of surgery, the use of preoperative embolization of adrenal tumors has received unreasonably little attention in the literature.

Conclusion

Summing up, we can conclude that the progress of recent decades in adrenal surgery is largely associated with the introduction and widespread use of endovideosurgical methods. From the moment of their appearance, the main and most demanded vector of their development is associated with the expansion of indications for them. Many aspects of their application, which were previously the subject of active discussion, have lost their relevance with the accumulation of experience. Nevertheless, the use of the method in surgery of large and malignant tumors is still controversial.

Expansion of indications for performing Endo-Video-Surgical interventions requires further extensive scientific research. In this regard, preoperative embolization of large adrenal tumors is an underestimated option and deserves a comprehensive study.

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