Laparoscopic partial adrenalectomy in patients with hereditary forms of pheochromocytoma

Purpose: Patients with von Hippel-Lindau disease are predisposed to multipl e bilateral adrenal pheochromocytoma. In these patients partial adrenalecto my may preserve adrenocortical function and avoid the morbidity associated with medical adrenal replacement. We report our experience with such cases. Materials and Methods: Laparoscopic partial adrenalectomy was performed in patients with von Hippel-Lindau disease and pheochromocytoma when there was evidence of normal adrenocortical tissue on preoperative imaging or intrao perative examination. Suture ligature or a harmonic scalpel was used to exc ise the tumors, leaving a 2 to 3 mm. margin of normal tissue. Results: Two patients underwent laparoscopic partial adrenalectomy and 1 la paroscopic bilateral partial adrenalectomy with preservation of normal adre nocortical tissue. Seven pheochromocytomas were removed. Laparoscopic ultra sound was essential for localizing 2 pheochromocytomas that were not visual ized by the camera. Median operative time was 324 minutes, blood loss 100 c c and parenteral narcotic requirement 22 mg. morphine equivalents. No patie nt required hydrocortisone replacement. There has been no pheochromocytoma recurrence during short-term followup. Conclusions: Laparoscopic partial adrenalectomy is technically feasible in patients with a hereditary form of pheochromocytoma, and may preserve adren ocortical function. Laparoscopic ultrasound was necessary to identify 2 of the 7 pheochromocytomas removed.