THE ROLE OF INTRAOPERATIVE ULTRASONOGRAPHY DURING LAPAROSCOPIC ADRENALECTOMY

Background. The role of laparoscopic intraoperative ultrasonography (I OUS) in intraoperative decision making has grown rapidly in recent gea rs. The purpose of this study was to evaluate its usefulness during la paroscopic adrenalectomy. Methods. Since 1995, laparoscopic ultrasonog raphy has been used to evaluate the adrenal gland and surrounding orga ns in selective laparoscopic adrenalectomies. IOUS was performed in 19 of 114 laparoscopic adrenalectomies. Results. IOUS effected a change in management in 68% of these patients. IOUS displayed the location of the gland after a failed attempt at open resection; the adrenal vein, expediting control in four operations; no extraadrenal involvement by true large lesions (benign); vascular invasion in one tumor (carcinom a), prompting open resection; periadrenal invasion by one metastatic c ancer and lymph node involvement in another; a 7 mm hyperaldosteronoma ; no adenoma in two cases; bilateral hyperplasia; and a 14 cm cyst ori ginating from the adrenal gland. IOUS facilitated partial adrenalectom y in two patients and revealed centrally located adenomas in two other s requiring total adrenalectomy. Conclusions. Laparoscopic IOUS during adrenal operation is valuable in selected cases. It is helpful to loc ate the gland and vein, confirm the presence or absence of abnormality , discern the resectability of large masses, and facilitate a partial adrenalectomy when desirable.