Comparison of the hemodynamic parameters of open and laparoscopic adrenalectomy for pheochromocytoma

Laparoscopic adrenalectomy has gained widespread popularity For treating a variety of adrenal disorders including pheochromocytoma, but the effects of pneumoperitoneum on the hemodynamics of patients with catecholamine-secret ing tumors are poorly understood. The goal of this study was to compare the effects of carbon dioxide pneumoperitoneum and tumor manipulation on the h emodynamic parameters in two groups of patients with sporadic pheochromocyt omas less than 7 cm in size. Group 1 patients (n = 11) underwent lateral tr ansabdominal laparoscopic adrenalectomy, and group 2 (n = 11) underwent adr enalectomy by the open anterior approach. The mean follow-up was 37 months in group 1 (range 26-51 months) and 52 months in group 2 (range 27-72 month s). All patients undergoing laparoscopic adrenalectomy experienced intraope rative hypertension (blood pressure greater than or equal to 200/90 mmHg), as did 73% with the open approach, but the difference was not significantly different. Intraoperative hypotension (systolic blood pressure < 80 mmHg) occurred in four group 1 patients compared to six patients in group 2. Mean arterial pressure, central venous pressure, and pulmonary capillary wedge pressure were significantly higher in group 1 patients prior to tumor excis ion, but there was no difference in pulse, cardiac index, or left ventricle work index at any point during the procedure. There were no conversions or complications in the laparoscopic group; one patient in group 2 developed an incisional hernia. Although Laparoscopic adrenalectomy for pheochromocyt oma is associated with a greater increase in mean arterial pressure, centra l venous pressure, and pulmonary capillary wedge pressure, the creation of pneumoperitoneum does not significantly change the cardiac index or left ve ntricle work index. Carbon dioxide pneumoperitoneum is well tolerated in pa tients with pheochromocytoma.