Laparoscopic treatment of adrenal cysts — own research and literature review

  Materiał i metody: W ciągu ostatnich 18 miesięcy autorzy pracy operowali 6 chorych z dużymi torbielami nadnerczy. Stanowi to 8,2% wszystkich chorych leczonych w tym okresie z powodu patologii w obrębie nadnerczy. Po wykluczeniu złośliwego i pasożytniczego charakteru patologii wszystkich chorych operowano z intencją wycięcia torbieli z oszczędzeniem samego gruczołu. U pięciu chorych resekowało samą torbiel z oszczędzeniem nadnercza, natomiast u jednego na ścianach torbieli opłaszczone było całe nadnercze, co zmusiło do adrenalektomii łącznie z cystektomią. W czasie operacji starano się też nie klipsować żyły nadnerczowej, co udało się w 4/6 przypadków. Wyniki: Obserwacja odległa od 3 do 12 miesięcy nie wykazała nawrotu torbieli w obrazowaniu kontrolnym USG/CT. We wszystkich przypadkach udało się natomiast uwidocznić pozostawione nadnercze. Wnioski: Autorzy uważają, że resekcja łagodnych torbieli jest postępowaniem uzasadnionym i godnym polecenia. (Endokrynol Pol 2015; 66 (5): 469–472)    Material and methods: Over the last 18 months we operated on six patients with large adrenal gland cysts in our centre. This consisted of 8.2% of all patients treated in said period due to adrenal gland pathologies. On ruling out malignancy or parasitic nature of the lesions, all patients were surgically treated in order to excise the cysts while leaving the gland untouched. In five patients the cysts were resected but the adrenal gland was spared. However, in one patient the adrenal gland coated the entire cystic mass, which imposed performance of adrenalectomy in addition to cystectomy. During surgeries we tried not to clip the suprarenal vein, which we managed to do in four out of six cases. Results: A one-year remote follow-up period revealed no cyst recurrence in ultrasound or CT, and it was possible to visualise the remaining part of the adrenal gland in all cases. Conclusion: Thus, in our opinion resection of benign cysts is well justified and recommendable. (Endokrynol Pol 2015; 66 (5): 469–472)

Laparoscopic Adrenalectomy - Assessing the Learning Curve

Laparoscopic adrenalectomy (LA) has become the "gold standard" for treatment of most of adrenal tumors in last few years. It has many benefits comparing to open surgery, but still is considered as complicated procedure requiring experienced surgical team.The aim of the study was to assess the learning curve of laparoscopic adrenalectomy and the outcome of the first consecutive 154 LA.Material and methods. 154 consecutive patients undergoing LA between 2007 and 2010 were reviewed. Collected data included: patients demographics, clinical and histological diagnosis, side and length of operation, conversions to open surgery, complications and hospitalization time. Learning curve was evaluated by dividing all patients into three groups (group I - first 50 patients, group II - second 50 patients and group III last 54 patients). Differences between the groups were analyzed.Results. There were 154 LAs performed. Indications for LA were hormonally inactive adrenal adenoma(n=57), Conn's syndrome (n=30), Cushing's syndrome (n=28), pheochromocytoma (n=27), adrenal cyst (n=8), and others (n=4). Mean tumor size was 45.28 mm. There were 79 left-sided and 75 right-sided procedures and the average time of hospitalization was 4.64 days. Mean operative time was statistically different between the groups (216.2 min. - 164.6 min. - 131.9 min.; p<0.01) as well as the number of conversions to open surgery (18% - 4% - 3.7%; p=0.013). There was not any significant difference in the number of complications between analyzed groups (2% - 2% -3.7%).Conclusion. To improve the outcome of LA it is necessary to perform approximately 40 to 50 procedures

The local spread of pheochromocytoma after adrenalectomy with a rupture of the tumor capsule at the time of the surgery

Introduction: We present a case of a 29-year-old patient treated due to fully symptomatic pheochromocytoma of the right adrenal gland

Przydatność adrenalektomii laparoskopowej w leczeniu nowotworów nadnerczy w doświadczeniu jednoośrodkowym

Introduction: Adrenal neoplasms comprise about 10% of all tumours affecting this organ and constitute a significant, at first diagnostic and subsequently therapeutic, problem, especially since a relatively high proportion of neoplastic lesions are asymptomatic. The number of diagnosed metastases to adrenal glands is increasing. Surgical treatment involves both open surgery as well as laparoscopy. Material and methods: There were 245 adrenalectomies performed at our centre due to various indications over the past four years. In 27 (11.5%) cases neoplasms were diagnosed in the final histopahtological examination. In 11 (40.7%) cases primary adrenal cortex tumours were diagnosed, metastases from other solid organ tumours were identified in another 12 (44.4%) patients, and rarer neoplasms were diagnosed in the remaning 4 (14.8%) subjects. Cases of malignant pheochromocytoma were not included in this report. Results: Laparoscopic adrenalectomy was performed in 23 (85.2%) subjects, while the ramaining 4 (12.9%) patients were subject to open adrenalectomy (conversion to open procedure in one case). There were no deaths or significant complications in the perioperative period. Comparing mean duration of open (140 minutes) and laparoscopic (190 minutes) procedures yielded a statistically significant difference (p = 0.02). There was no statistically significant difference found in the duration of operation with regard to laparoscopic adrenalectomies of tumours less than 50 mm and over 55 mm in diameter (p = 0.16). Conclusions: Laparoscopic adrenalectomy is a safe and effective method of treatment of adrenal tumours. Its oncological completeness is comparable (to open surgery) when performed by experienced surgical teams. Laparoscopy is the reason for the smooth postoperative course observed in most patients.Wstęp: Nowotwory nadnerczy występują w około 10% wszystkich guzów tego narządu i stanowią bardzo istotny problem początkowo diagnostyczny, a następnie leczniczy. Tym bardziej, że dość duży odsetek zmian nowotworowych nadnerczy przebiega bezobjawowo. Stwierdza się też coraz więcej zmian przerzutowych do nadnerczy. Leczenie jest chirurgiczne zarówno metodami chirurgii otwartej, jak i laparoskopowej. Materiał i metody: W okresie ostatnich 4 lat w tutejszym ośrodku wykonano 245 adrenalektomii z różnych wskazań. U 27 (11,5%) w ostatecznym badaniu histopatologicznym rozpoznano nowotwory. U 11 pacjentów (40,7%) rozpoznano pierwotne raki kory, u kolejnych 12 chorych (44,4%) przerzuty nowotworów narządowych, u pozostałych 4 (14,8%) inne rzadsze nowotwory. W opracowaniu nie uwzględniono złośliwych postaci pheochromocytoma. Wyniki: U 23 (85,2%) wykonano adrenalektomię laparoskopową, u pozostałych 4 (12,9%) adrenalektomię otwartą (w jednym przypadku była to konwersja). W okresie okołooperacyjnym nie było zgonów ani istotnych powikłań. Ten przedłużony pobyt związany był z przekazaniem chorych do dalszego leczenia skojarzonego. Porównano średnie czasy trwania operacji otwartych (140 min) i laparoskopowych (190 min) uzyskując statystyczną znamienność (p = 0,02). Nie uzyskano znamienności statystycznej w czasie trwania adrenalektomii laparoskopowych dla guzów o średnicy do 50 mm i powyżej 55 mm (p = 0,16). Wnioski: Adrenalektomia laparoskopowa jest bezpieczną i skuteczną metodą leczenia nowotworów nadnerczy. Jest też porównywalna w doszczętności onkologicznej gdy jest wykonywana przez doświadczone zespoły operacyjne. Laparoskopia u większości operowanych ma łagodny przebieg pooperacyjny

Results of General Surgical Treatment of Patients Over 80 Years of Age in Single-Site Experience

The aim of the study was to evaluate the results of general surgical treatment of patients over 80 years of age.Material and methods. Three hundred and four patients aged 80 to 105 years with general surgical disorders, treated in 2005-2009, were retrospectively included in the study. The collected information included demographic data, coexisting diseases, the mode of admission, the diagnosis, the method and result of treatment, and also potential complications and 30-day mortality. The data were subjected to statistical analysis.Results. The study group included 186 women and 118 men. Two hundred patients (65.8%) were admitted in an emergency setting. The most common causes of immediate hospitalisation were: mechanical ileus (26.5%), gastrointestinal bleeding (22%), trauma (16%), and gall-bladder disorders (8.5%). The remaining 104 (34.2%) patients were operated upon on an elective basis. An emergency operation was required by 121 (60%) of the patients admitted in an emergency setting; the remaining ones were treated conservatively. Hernia plasties (27.5%), cholecystectomies (15.3%), colorectal resections (13.2%), strumectomies (11.2%) and endoscopies (6.1%) predominated among elective surgeries.The total number of complications and mortality were 19.4% and 14.5%, respectively. The number of complications and mortality were significantly higher in the group of patients admitted in an emergency setting (25.5% and 20.5%, respectively) than in patients admitted on an elective basis (8.7% and 2.9%, respectively), p<0.01.The mean duration of hospitalisation was 9.7 days (1 to 60 days), with a small difference between the groups of patients treated on an elective and emergency basis (8.5 and 10.4 days), p=0.181.Conclusions. The results of surgical treatment of elderly patients do not significantly differ from the results of treatment of the general population. Much worse results, coupled with a significant increase in mortality, are observed in patients admitted and treated on an emergency basis

Anastomotic aneurysms- 20-years of experience from one center

Anastomotic aneurysms may develop after any type of vascular surgery, in different areas of the arterial system, and require reoperation. The frequency of occurrence of the above-mentioned is estimated at 1-5%. Material and methods. During the period between 1989 and 2010, 180 patients with 230 anastomotic aneurysms were subject to surgical intervention at the Department of General and Thoracic Surgery, Warsaw Medical University. The study group comprised 21 (11.7%) female and 159 (88.3%) male patients, aged between 30 and 87 years (mean age - 62.8 years). In relation to the number of anastomoses aneurysms were diagnosed in 2.1% of cases. Twenty-four (10.4%) patients were diagnosed with recurrent aneurysms. Results. Surgical procedures performed were as follows: artificial prosthesis implantation (119), reanastomosis (40), patch plasty (25), graftectomy (19), prosthesis replacement (9), and stent-graft (7) implantation. 195 (84.8%) aneurysms were subject to planned surgery, while 35 (15.2%) required emergency intervention. 77.8% of patients were diagnosed with aseptic aneurysms, while the remaining 22.2% with infected perioperative aneurysms. Good treatment results were obtained in 149 (82.8%) patients. Limb amputations were performed in 19 (10.5%) cases. Twelve (6.7%) patients died as a consequence of infection and general complications. Conclusions. Vascular reoperations are a difficult clinical problem and are burdened with a high rate of complications. The above-mentioned often require complex treatment, in order to improve therapeutic results

Location and Incidence Rate of Anastomotic Aneurysms – own Clinical Material and Literature Review

Anastomotic aneurysms occurs at various levels of arterial system. Determining their location and incidence rate required investigation of large patient clinical material. Material and methods. In the years 1989-2010 in local centre 230 anastomotic aneurysms were operated in 180 patients. Results. For 187 (81.3%) patients anastomotic aneurysms were localised in the groin, while for remaining 43 (18.7%) they occurred in other localisations. In aortic arch branch they occurred four times (1.7), in descending aorta - three times (1.3%), in abdominal aorta - 14 (6.1%) and in iliac arteries - 6 (2.6%). While for anastomosis with popliteal artery they were diagnosed in 16 (7%) patients. Own clinical material was compared with literature data. Conclusions. Anastomotic aneurysms in over 80% of cases occur in the groin, remaining percentage corresponds to other localisations