THE LAPAROSCOPIC APPROACH TO PHEOCHROMOCY TOMAS - IS IT SURGICALLY AND HEMODYNAMICALLY SAFE - THE PROSPECTIVE-STUDY OF 6 PATIENTS

Today, laparoscopy is for us the technique of choice for approaching p resumed benign adrenal tumors. With regards to pheochromocytoma howeve r, two major questions must be addressed. First, is it acceptable to r esect potentially multifocal tumors with such a targeted approach ? Se cond, can peroperative hemodynamic changes be anticipated and controll ed by the anesthetist, taking into account the additional effects of p neumoperitoneum and catecholamine release on the cardiovascular system ? The present prospective study attempts to answer these two questions . From November 1993 to November 1995 we operated on four women and tw o men, with ages ranging from 33 to 71 years (mean of 47) and a mean B ody Mass Index of 25 kg/m2 (range 17-35). Four patients were assigned ASA (American Society of Anesthesiologists) physical status 2, one gra de 1 and one grade 3. Comprehensive preoperative work-up, including a CT scan and an I-131 MIBG Scan in all, a C-11 Hydroxyephedrine PET Sca n in 4 and a MRI in one patient, showed a solitary lesion in each case . There were four right-sided and two left-sided tumors, ranging from 30 to 60 mm in diameter. Laparoscopy was always performed transperiton eally. Systemic and pulmonary hemodynamics were thoroughly assessed. E pinephrin and norepinephrin concentrations were measured at the 10 key -time of surgery. Use of continuous intravenous infusion of nicardipin e allowed tight control of hemodynamics despite impressive increases i n circulating catecholamines. The mean operative time was 76 minutes ( range 59-130). Blood loss was minimal. We observed neither mortality n or morbidity. Mean hospital stay ranged from 3 to 13 days (median = 3) . All patients are normotensive without drug after a follow-up of 9 to 33 months. In conclusion, we think that laparoscopic removal of selec ted cases of pheochromocytoma may be performed safely from both the he modynamical and oncological standpoints.