Laparoscopic adrenalectomy in a consecutive series of patients

Parnaby, Craig N. (2011) Laparoscopic adrenalectomy in a consecutive series of patients. MSc(R) thesis, University of Glasgow.

Abstract

Laparoscopic adrenalectomy (LA) has become the procedure of choice for most adrenal pathologies. A number of uncertainties remain which include:
1. The impact of variable adrenal vasculature on LA.
2. The blood supply to the adrenal remnant after subtotal adrenalectomy.
3. Haemodynamic changes during LA for phaeochromocytoma resection.
4. The role of LA for large adrenal tumours (≥6cm).
5. The outcomes of patients undergoing open adrenalectomy (OA) in a series where LA is performed routinely.
6. The role of LA for isolated adrenal metastasis.
The aim of the thesis was to examine these uncertainties using our adrenalectomy series (Jan 1999 – Jan 2009) and anatomical dissection.
We found:
1. The main adrenal vein was remarkably constant and multiple small arteries and veins surround the adrenal gland.
2. During laparoscopic subtotal adrenalectomy, a non functioning adrenal remnant would be unlikely due to an inadequate arterial supply or due to division of the main adrenal vein.
3. LA for phaeochromocytoma was associated with increased episodes of severe intraoperative hypertension (systolic blood pressure 200-220mmHg) when compared to the laparoscopic resection of other adrenal tumours. There were no other significant differences in terms of hypotensive episodes, cardiac arrhythmias or intravenous fluid requirements.
4. In the absence of local invasion, LA for tumours ≥6cm has shown that oncological outcome and post-operative morbidity were comparable to LA for tumours <6cm.
5. In a series where LA was routine, OA was performed infrequently. In the absence of the requirement for an additional open procedure, OA was a demanding procedure associated with resection of adjacent structures and high local recurrence rates.
6. The recovery and oncological outcomes for isolated adrenal metastasis from a renal origin compared very favourably to other series where a more selective policy for laparoscopy was adopted.

• Item Type: Thesis (MSc(R))
• Qualification Level: Masters
• Keywords: Laparoscopy, adrenalectomy, adrenal blood supply, phaeochromocytoma, adrenal metastases
• Subjects: R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer); R Medicine > RD Surgery
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Cancer Sciences
• Supervisor's Name: O'Dwyer, Professor Patrick
• Date of Award: 2011
• Depositing User: Mr Craig/ CN Parnaby
• Unique ID: glathesis:2011-3013
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 14 Nov 2011
• Last Modified: 10 Dec 2012 14:02
• URI: https://theses.gla.ac.uk/id/eprint/3013