LAPAROSCOPIC APPROACH TO PHEOCHROMOCYTOMA - HEMODYNAMIC-CHANGES AND CATECHOLAMINE SECRETION

This study compares the outcome of laparoscopic adrenalectomy (LpA) in 23 patients using CO2 insufflation with the outcome of this procedure in another 8 patients with pheochromocytoma (7 unilateral, 1 bilatera l) using helium for pneumoperitoneum. The adrenal lesions in the first group included nonfunctional adenoma (n = 3), aldosterone adenoma (n = 11), Gushing's adenoma (n = 6), and Gushing's disease (n = 3). The l atter patients were compared with a third group of 8 patients with phe ochromocytoma undergoing conventional transabdominal adrenalectomy (CT A). With both procedures, intraoperative changes in plasma catecholami ne levels were studied during pheochromocytoma removal and the changes correlated with intraoperative cardiovascular derangements. LpA was s uccessfully performed in 95% of patients with adrenal lesions and in 1 00% of patients with pheochromocytoma. There was no significant differ ence in laparoscopic adrenalectomy for pheochromocytoma compared to th at for other adrenal lesions in terms of operative time, blood loss, h ospital stay, analgesic requirements, and return to normal activity. T he outcome was less favorable in pheochromocytoma patients undergoing CTA. The largest increase of catecholamine levels in pheochromocytoma patients occurred during tumor manipulation with both LpA (17.4-fold f or epinephrine and 8.6-fold for norepinephrine) and CTA (34.2-fold for epinephrine and 13.7-fold for norepinephrine), but cardiovascular ins tability was associated only with CTA. LpA may become the technique of choice for surgical removal of adrenal lesions and may also become th e preferred method for removing pheochromocytoma.