LAPAROSCOPIC REMOVAL OF PHEOCHROMOCYTOMA - WHY - WHEN - AND WHO - (REFLECTIONS ON ONE CASE-REPORT)

Until now, the need for wide exposure and nonmanipulative dissection o f pheochromocytoma has dictated the use of a large intraperitoneal tra nsabdominal approach, which unfortunately results in a significant inc idence of morbidity. A unilateral retroperitoneal approach guided by t he refinements of new imaging techniques is less invasive but is assoc iated with a small risk of incomplete cure. In one case report, we tes ted the hypothesis that laparoscopic surgery could combine the benefic ial effects of both operative strategies without their respective side effects. We concluded that a laparoscopic approach combined with excl usive intraoperative infusion of nicardipine, a calcium-channel blocke r, can be used to surgically remove pheochromocytoma under stable hemo dynamic conditions. This provides better exposure of the anatomical st ructures than open surgery and allows a visual exploration of the enti re abdominal cavity to exclude tumor multicentricity or ectopic sites in the case of inconclusive preoperative imaging investigations. Moreo ver, conversion to open surgery is always possible if needed.