Laparoscopic adrenalectomy for phaeochromocytoma: endocrinological and surgical aspects of a new therapeutic approach

OBJECTIVES To evaluate the results of laparoscopic resection of phaeochromo cytoma with a focus on pre- and intra-operative endocrinological and pharma cological aspects. DESIGN Retrospective study based on review of case notes and intraoperative anaesthetic records. PATIENTS Eight patients (four men, four women) aged 13 to 70 (median: 45) y ears with symptomatic phaeochromocytoma (two patients with MEN IIa syndrome ) diagnosed 6-36 months before adrenalectomy in four patients and just befo re operation in the four remaining patients. All patients presented with hy pertension. MEASUREMENTS Pre- and postoperative blood pressure (BP) was assessed using a sphygmomanometer, intraoperative measurements being obtained by intraarte rial line. Adrenaline (A), noradrenaline (NA), metadrenaline (metA), normet adrenaline (normetA) and vanillylmandelic acid (VMA) were measured in 24-h urine samples, Adrenal imagery consisted in all patients of abdominal compu ted tomography and [I-131] metaiodobenzylguanidine (MIBG) scintigraphy, and in 2 patients, adrenal magnetic resonance imaging and octreotide scintigra phy, Determination of plasma volume was performed by isotopic method. RESULTS Median (range) preoperative systolic and diastolic BP was 140 (130- 240) and 90 (80-150) mm Hg, respectively. Predominant catecholamine secreti on consisted of A in four patients (A pattern) and of NA (NA pattern) in th e other four. Tumours smaller than 30 mm usually secreted A while larger on es secreted NA. Pre- and intra-operative BP control was straightforward in all but two patients with preferential NA secretion. The median number of s ystolic and diastolic BP peaks were higher in patients with NA pattern (n = 6, range: 3-9) than in those with A pattern (n = 1.5, range: 1-6). Total d uration of pneumoperitoneum ranged from 120 to 240 (median: 195) min. Intra - and post-operative complications included intraabdominal bleeding, laparo scopically controlled (in one case), and upper pole kidney ischaemia in ano ther. Postoperative hospital stay ranged from 4 to 11 days. All patients we re asymptomatic postoperatively and pharmacologically controlled hypertensi on persisted in two of them CONCLUSIONS Laparoscopic adrenalectomy is a safe and efficient technique to remove phaeochromocytoma in terms of intra- and postoperative morbidity, w ith a low complication rate. Pre- and intra-operative pharmacological blood pressure control is as effective as in conventional adrenalectomy, with gr eater instability in noradrenaline secreting tumours.