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Robot-assisted adrenalectomy:Step-by-step technique and surgical outcomes at a high-volume robotic center

Asian Journal of Urology 2023年第4期10卷 475-481页

作者： Federico Piramide Carlo Andrea Bravi Marco Paciotti Luca Sarchi Luigi Nocera Adele Piro Maria Peraire Lores Eleonora Balestrazzi Angelo Mottaran Rui Farinha Hubert Nicolas Pieter De Backer Frederiek D'hondt Peter Schatteman Ruben De Groote Geert De Naeyer Alexandre Mottrie Department of Urology Onze-Lieve-VrouwziekenhuisAalstBelgium ORSI Academy GhentBelgium Department of Oncology Division of UrologyUniversity of TurinSan Luigi Gonzaga HospitalTurinItaly Department of Urology Humanitas Research Hospital-IRCCSRozzanoItaly Department of Urology ASST Santi Paolo e CarloUniversity of MilanMilanItaly Unit of Urology Division of Experimental OncologyUrological Research InstituteIRCCS San Raffaele Scientific InstituteVita-Salute San Raffaele UniversityMilanItaly Department of Urology Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense ModenaUniversity of Modena and Reggio EmiliaModenaItaly Division of Urology IRCCS Azienda Ospedaliero-Universitaria di BolognaBolognaItaly Urological Department La CitadelleLiègeBelgium

Objective In the last years,robotic surgery was introduced in several different settings with good perioperative results.However,its role in the management of adrenal masses is still debated.In order to provide a contribution to this field,we described our step-by-step technique for robotic adrenalectomy(RA)and related modifications according to the type of adrenal mass treated.Methods We retrospectively analyzed 27 consecutive patients who underwent RA at Onze-Lieve-Vrouw hospital(Aalst,Belgium)between January 2009 and October 2022.Demographic,intra-and post-operative,and pathological data were retrieved from our prospectively maintained institutional database.Continuous variables are summarized as median and interquartile range(IQR).Categorical variables are reported as frequencies(percentages).Results Twenty-seven patients underwent RA were included in the study.Median age,body mass index,and Charlson's comorbidity index were 61(IQR:49-71)years,26(IQR:24-29)kg/m^(2),and 2(IQR:0-3),respectively,and 16(59.3%)patients were male.Median tumor size at computed tomography scan was 6.0(IQR:3.5-8.0)cm.Median operative time and blood loss were 105(IQR:82-120)min and 175(IQR:94-250)mL,respectively.No intraoperative complications were recorded.Overall postoperative complications rate was 11.1%,with a postoperative transfusion rate of 3.7%.A total of 10(37.0%)patients harbored malignant adrenal masses.Among them,3(11.1%)had adrenocortical carcinoma,6(22.2%)secondary metastasis,and 1(3.7%)malignant pheochromocytoma on final pathological exam.Only 1(10.0%)patient had positive surgical margins.Conclusion We described our step-by-step technique for RA,which can be safely performed even in case of high challenging settings as malignant tumors,pheochromocytoma,and large masses.The standardization of perioperative protocol should be encouraged to maximize the outcomes of this complex surgical procedure.

关键词： Robotics adrenalectomy Pheochromocytoma Malignant Surgical technique

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Effect of adrenalectomy and hydrocortisone on ventral prostate of rats

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Asian Journal of Andrology 2001年第4期3卷 289-300页

作者： Neena Nair R.S.Bedwal R.S.Mathur Cell Biology Laboratory Department of Zoology University of Rajasthan Jaipur 302004 IndiaCell Biology Laboratory Department of Zoology University of Rajasthan Jaipur 302004 IndiaCell Biology Laboratory Department of Zoology University of Rajasthan Jaipur 302004 India

Aim: To study the effects of adrenalectomy and hydrocortisone on the ventral prostate of SD rats. Methods: Inadrenalectomised (ADX) and ADX + hydrocortisone (1, 2, or 4 mg) treated rats, the prostatic histology and thecholesterol, protein, zinc, and copper levels and the enzymic profile (acid phosphatase, alkaline phosphatase, aryl sul-phatase, lactic dehydrogenase, and leucine aminopeptidase) in the prostatic tissue were determined; the serum hormon-al profile (testosterone, FSH and LH) was also assayed. Results; adrenalectomy caused a progressive degenerationin prostatic structure that was not reversed by hydrocortisone treatment. The serum testosterone were significantly lowerin ADX than in sham operated rats and lower in ADX + hydrocortisone than in ADX-C rats (P adrenalectomy leads to pathological and func-tional changes of the prostate. Hydrocortisone treatment at the doses employed did not reverse these changes. (Asian JAndrol 2001 Dec; 3: 289 - 300)

关键词： adrenalectomy ventral prostate hydrocortisone testosterone FSH LH cholesterol zinc copper acid phosphatase alkaline phosphatase aryl sulphatase lactic dehydrogenase leucine aminopeptidase

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Role of adrenalectomy in recurrent Cushing＇s disease

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Chinese Medical Journal 2010年第13期123卷 1658-1662页

作者： DING Xue-fei LI Han-zhong YAN Wei-gang GAO Ying LI Xiao-qiang Department of Urology Peking Union Medical College Hospital Peking Union Medical College & Chinese Academy of Medical Sciences Beijing 100730 China Department of Obstetrics and Gynecology Department of Urology Affiliated Hospital of North China Coal Medical College Tangshan Hebei 063000 China

Background Cushing＇s disease is a pituitary-dependent type of Cushing＇s syndrome. Treatment consists of pituitary surgery or radiotherapy, but the recurrence rate at 10 years is as high as 40%. adrenalectomy is considered an effective treatment to refractory Cushing＇s disease. The objective of this study was to examine the efficacy of laparoscopic adrenalectomy and open adrenalectomy in Cushing＇s disease, focusing on reversing the sequelae of hypercortisolism and improving patients＇ quality of life. Methods Forty-three patients （29 women, 14 men） with recurrent Cushing＇s disease after transsphenoidal operation underwent laparoscopic （n=32） or open （n=11） adrenalectomy from 2000 to 2008. Surgical results were evaluated for all the 43 patients. Patients completed a follow-up survey, including the short-form 36-item （SF-36） health survey. Results All the 43 patients achieved clinical reversal of hypercortisolism after adrenalectomy. Time to symptom resolution varied from a few weeks to up to 3 years. Most physical changes had resolved by a mean of 8 months after surgery. These conditions were not significantly different between the laparoscopy and open groups. Median length of hospital stay was shorter in the laparoscopy group （4 vs. 9 days; P 〈0.001）. Median follow-up was 48.5 months. Of the 34 （79%） patients available for follow-up, 22 （65%） had adrenocorticotropic hormone levels 〉200 ng/ml and 6 （27%） had clinical Nelson syndrome. Four patients died by 75 months after surgery. Using SF-36, 30 （88%） patients reported they felt their health status was good to excellent compared with 1 year before adrenalectomy; however, they showed significantly lower scores in all the 8 SF-36 parameters compared with the general population. No significant difference emerged in SF-36 scores between the laparoscopy and open groups. Conclusions adrenalectomy showed high survival and clinical benefits in recurrent Cushing＇s disease patients. Despite patient-reported improvement in health after adrenalectomy, patients continue to exper

关键词： adrenal gland Cushing＇s disease adrenalectomy laparoscopy

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Primary adrenal Ewing sarcoma:A systematic review of the literature

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世界临床病例杂志 2023年第28期11卷 6782-6791页

作者： Dimitrios K Manatakis Ioannis Tsouknidas Emmanouil Mylonakis Nikolaos Tasis Maria Ioanna Antonopoulou Vasileios Acheimastos Aikaterini Mastoropoulou Dimitrios P Korkolis 2^(nd)Department of Surgery Athens Naval and Veterans HospitalAthens 11521Greece General Surgery Lankenau Medical CenterMain Line HealthWynnewoodPA 19096United States Department of Surgical Oncology St Savvas Cancer HospitalAthens 11522Greece Department of Surgery Naval Hospital of CreteChania 73200Greece Department of Pediatrics Stony Brook University HospitalStony BrookNY 11794United States

BACKGROUND Ewing sarcoma(ES)is a malignant neoplasm of neuroectodermal origin and is commonly observed in children and young adults.The musculoskeletal system is the main body system impacted and ES is rarely seen in the visceral organs particularly the adrenal gland.AIM To present a comprehensive review of primary adrenal ES,with emphasis on diagnosis,therapy and oncological outcomes.METHODS A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020.PubMed/MEDLINE,EMBASE and Google Scholar bibliographic databases were searched to identify articles from 1989 to 2022 and included patients with ES/primitive neuroectodermal tumor(PNET)of the adrenal gland.PubMed,Google Scholar and EMBASE medical databases were searched,combining the terms“adrenal”,“ES”and“PNET”.Demographic,clinical,pathological and oncological data of patients were analyzed by SPSS version 29.0.RESULTS A total of 52 studies were included for review(47 case reports and 5 case series)with 66 patients reported to have primary adrenal ES.Mean age at diagnosis was 26.4±15.4 years(37.9%males,57.6%females,sex not reported in 3 cases).The most frequent complaint was abdominal/flank pain or discomfort(46.4%)followed by a palpable mass(25.0%),and the average duration of symptoms was 2.6±3.1 mo.The imaging modality of choice was computed tomography scan(81.5%),followed by magnetic resonance imaging(20.4%).Preoperative staging revealed that 17 tumors(27.9%)were metastatic and 14 patients had inferior vena cava or renal vein neoplastic thrombus at initial diagnosis.Open adrenalectomy was performed in the majority of cases(80.0%),of which 27.9%required more extensive resection.Minimally invasive surgery was attempted in 8.2%of tumors.Complete surgical resection was achieved in 89.4%of the patients.Adjuvant therapy was administered to 32 patients,in the form of chemotherapy(62.5%),radiotherapy(3.1%)or combination(34.4%).Median overall survival was 15 mo and 24-mo overall survival was

关键词： Ewing sarcoma Primary adrenal tumor adrenalectomy

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Effect of adrenalectomy on rat epididymidis

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Asian Journal of Andrology 2002年第4期4卷 273-279页

作者： Neena Nair R.S. Bedwal R.S. Mathur Cell Biology Laboratory Department of Zoology University of Rajasthan Jaipur-302 004 IndiaCell Biology Laboratory Department of Zoology University of Rajasthan Jaipur-302 004 IndiaCell Biology Laboratory Department of Zoology University of Rajasthan Jaipur-302 004 India

AIM: To investigate the effect of adrenalectomy (ADX) on the epididymidis of Sprague-Dawley rats. METHODS: The histological, biochemical (cholesterol protein, zinc, copper, alkaline and acid phosphatase aryl sulphatase, lactic dehydrogenase and leucine amino peptidase) and hormonal (FSH, LH and testosterone) changes of caput and cauda epididymis in ADX rats were observed. RESULTS: Organ wet weight, histological studies and morphometric measurements indicated a cellular degeneration in caput and cauda epididymis of ADX rats. Serum testosterone level was significantly lower in ADX than in sham-operated rats, while the serum FSH and LH were below the detection limit of 1 mIU/mL. The enzymatic activity was higher in ADX than in sham-operated rats. Epididymal zinc level increased whereas copper level decreased in ADX rats compared to the sham-operated. CONCLUSION: adrenalectomy leads to degeneration of caput and cauda epididymidis epithelial cells as a result of decreased supply of testosterone.

关键词： adrenalectomy Acid Phosphatase Alkaline Phosphatase Animals Arylsulfatases Cholesterol Comparative Study Copper Epididymis Follicle Stimulating Hormone L-Lactate Dehydrogenase Leucyl Aminopeptidase Luteinizing Hormone Male Organ Size Rats Rats, Sprague-Dawley Reference Values Research Support, Non-U.S. Gov't Testosterone Time Factors Zinc

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omemade Single-port Laparoscopic Retroperitonea adrenalectomy

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Chinese Medical Journal 2015年第14期128卷 1983-1984页

作者： Huai-Zhen Geng Gui-Ju Meng Wen Tong Jun-Mei Zhou Jin-Tao Li Department of Urology Heze Municipal Hospital Heze Shandong 274031 China Department of ICU Heze Municipal Hospital Heze Shandong 274031 China Operation Room Affiliated Hospital of Taishan Medical College Tai'an Shandong 271000 China Department of Urology Affiliated Hospital of Taishan Medical College Tai'an Shandong 271000 China

To the Editor： Laparoendoscopic single-site surgery （LESS） has been widely used for various urologic diseases in order to improve safety, outcomes, and cosmesis, and to further reduce invasiveness. Here, we reported our initial experience with laparoendoscopic single-site retroperitoneal partial adrenalectomy using a homemade single-port device in a municipal hospital.

关键词： Homemade Single-port Laparoscopic Retroperitoneal adrenalectomy

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Minimally invasive techniques in benign and malignant adrenal tumors

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World Journal of Clinical Cases 2022年第35期10卷 12812-12821页

作者： Ahmet Bulent Dogrul Omer Cennet Anıl Hilmi Dincer Department of General Surgery Hacettepe University Faculty of MedicineHacettepe UniversityAnkara 06100Turkey

Minimally invasive adrenalectomy has become the main treatment modality for most adrenal lesions.Both laparoscopic transabdominal and retroperitoneoscopic approaches are safe and feasible options,each with respective advantages,including better surgical outcomes,fewer complications,and faster recovery over open adrenalectomy.While open surgery remains a valid modality in treatment of adrenocortical cancer in the presence of some findings such as invasion,robotic platforms,and minimally invasive surgery have gained popularity as technology continues to evolve.Organ preservation during adrenalectomy is feasible in some conditions to prevent adrenal insufficiency.Ablative technologies are increasingly utilized in benign and malignant tumors,including the adrenal gland,with various outcomes.A multidisciplinary team,an experienced surgeon,and a highvolume center are recommended for any surgical approaches and management of adrenal lesions.This review article evaluated recent findings and current evidence on minimally invasive adrenalectomy.

关键词： adrenalectomy Laparoscopy Retroperitoneoscopic Minimally invasive surgery Robotic

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Laparoscopic adrenalectomy of a large pheochromocytoma in a multiple endocrine neoplasia-2A patient with renal agenesis

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Chinese Medical Journal 2013年第15期126卷 2996-2996页

作者： Wang Hai-dong Li Gui-zhong Wang Jian-wei Liu Ning He Feng Man Li-bo Beijing Jishuitan Hosp Dept Urol Beijing 100035 Peoples R China

Multiple endocrine neoplasia-2A （MEN 2A） is an autosomal dominant cancer syndrome characterized by medullary thyroid carcinoma, pheochromocytoma, and parathyroid hyperplasia. We report an unusual case of a patient who was associated with renal agenesis. Only two cases （a mother and her son） of one report were lbund in the literature.

关键词： Laparoscopic adrenalectomy pheochromocytoma

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Primary pigmented nodular adrenocortical disease: report of 5 cases

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Chinese Medical Journal 2006年第9期119卷 782-785页

作者： ZHU Yu WU Yu-xuan RUI Wen-bin LIU Ding-yi ZHOU Wen-long ZHANG Rong-ming SUN Fu-kang ZHANG Chong-yu SHEN Zhou-jun Department of Urology Ruijin Hospital Shanghai Jiao Tong University Shanghai 200025 China

Primary pigmented nodular adrenocortical disease （PPNAD）, found in the mid 1980s, is a rare type of ACTH-independent hypercortisolism, can be part of Carney complex （CNC）, an autosomal dominant multiple neoplasia syndrome characterized by spotty skin pigmentation, cardiac myxomas and endocrine tumors. One of the putative CNC genes, located on 17q22-24, has been identified as the regulatory subunit RIA of protein kinase A （PRKAR1A）. Patients with isolated PPNAD and no familial history of CNC can also present a germline de novo mutation of PRKAR1A. In China, five patients with PPNAD underwent surgical treatment in our department from 2001 to August 2004.

关键词： adrenal hyperplasia congenital diagnosis adrenalectomy

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Giant androgen-producing adrenocortical carcinoma with atrial flutter: A case report and review of the literature

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World Journal of Clinical Cases 2021年第20期9卷 5575-5587页

作者： Mircea-Florin Costache Raluca-Elena Arhirii Simona-Juliette Mogos Corina Lupascu-Ursulescu Cezara-Ioana Litcanu Adi-Ionut Ciumanghel Catalina Cucu Cristina-Mihaela Ghiciuc Antoniu-Octavian Petris Nicolae Danila Surgery Clinic Saint Spiridon University Clinical Emergency HospitalIasi 700111Romania Cardiology Clinic Saint Spiridon University Clinical Emergency HospitalIasi 700111Romania Department of Endocrinology Faculty of MedicineGrigore T.Popa University of Medicine and PharmacyIasi 700115Romania Endocrinology Clinic Saint Spiridon University Clinical Emergency HospitalIasi 700111Romania Department of Radiology and Imaging Sciences Grigore T.Popa University of Medicine and PharmacyIasi 700115Romania Radiology Clinic Saint Spiridon University Clinical Emergency HospitalIasi 700111Romania Radiotherapy Clinic Regional Institute of OncologyIasi 700483Romania Anesthesia and Intensive Care Department Grigore T.Popa University of Medicine and PharmacyIasi 700115Romania Anesthesia and Intensive Care Department Saint Spiridon University Clinical Emergency HospitalIasi 700111Romania Histopatology Department Saint Spiridon University Clinical Emergency HospitalIasi 700111Romania Department of Pharmacology Clinical Pharmacology and AlgesiologyFaculty of MedicineGrigore T.Popa University of Medicine and PharmacyIasi 700115Romania Department of Cardiology Faculty of MedicineGrigore T.Popa University of Medicine and PharmacyIasi 700115Romania Surgery Clinic Faculty of MedicineGrigore T.Popa University of Medicine and PharmacyIasi 700115Romania

BACKGROUND Adrenocortical carcinoma(ACC),the second most aggressive malignant tumor,lacks epidemiological data worldwide;therefore,every new case can improve the understanding of the pathology and treatment of this malignancy.CASE SUMMARY We present the case of a 66-year-old Caucasian woman with a giant androgenproducing ACC(21 cm×17 cm×12 cm;2100 g),without metastases,which unusually presented with an acute onset of atrial flutter and congestive heart failure.The cardiac complications observed in our case support the hypothesis that androgen excess in women is a cardiovascular risk factor.Androgen excess in women can be a rare cause of reversible dilated cardiomyopathy,therefore a comprehensive approach to the patient is essential to improve the recognition of androgen-secreting ACC.The atrial flutter was remitted after initiation of drug treatment during admission.The severe heart failure was totally remitted at 6 mo after radical open surgery to remove the giant ACC.CONCLUSION Radical open surgery to remove a giant androgen-producing ACC was the firstline treatment to cure the excess of androgen,which determined the total remission of cardiac complications at 6 mo after surgery in the women of this case report.

关键词： Adrenocortical carcinoma adrenalectomy Androgen secreting tumor Heart failure Atrial flutter Case report

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