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Objective To evaluate the recurrence and functional outcomes in a primarily hereditary cohort of patients undergoing partial adrenalectomy for pheochromocytoma. Methods A retrospective review from a prospectively managed database of patients undergoing partial adrenalectomy from 1995 to 2018 at the National Cancer Institute was performed. Local recurrence was defined as imaging evidence of a recurrent or de novo lesion on the operative side. Steroid dependency was defined as requiring daily steroid replacement at time of last follow-up. Results One hundred and twenty-four partial adrenalectomies, removing 162 tumors, were performed in 107 patients. Most patients had a known hereditary predisposition to develop bilateral, multifocal, and recurrent pheochromocytoma. Median tumor size was 2 cm (interquartile range (IQR) 1.5-2.8). Median follow-up was 60 months (IQR 13-131). Local recurrence occurred in 17 patients (15.8%) and were managed with active surveillance or surgery. A single patient (1/106, 0.9%) developed metastatic spread of pheochromocytoma approximately 14 years after his first of 2 partial adrenalectomies and remains alive under active surveillance. Median time to recurrence was 71 months (IQR 26-127) with 10 patients (9.3%) requiring daily steroid replacement at time of last follow-up. Conclusion Partial adrenalectomy offers excellent oncologic and functional outcomes, sparing most patients from lifelong steroid replacement therapy. Recurrences can be easily managed with repeat surgery or active surveillance via functional work-up and imaging. Partial adrenalectomy remains the recommended surgical management for patients pre-disposed to development of bilateral, multifocal and recurrent pheochromocytoma.

INTRODUCTION AND OBJECTIVE:Pheochromocytomas are rare, functional catecholamine producing neuroendocrine tumors that can be adrenal or extra adrenal in origin. Their estimated incidence is 0.1% in ...

INTRODUCTION AND OBJECTIVE:This is a demonstration of technique for robotic approach for partial adrenalectomy in a pediatric patient.METHODS:A 7-year-old female patient who presented with an incid...

Aim: For adrenal lesions which are functional and bigger than four centimeters, the optional therapy is surgery. Laparoscopy for the surgery of adrenal masses is increasingly used today. In the past, total adrenalectomy was performed for any adrenal lesions without any exception; however, bilateral involvement of tumors like pheochromocytoma causes trouble and forced surgeons to try partial adrenalectomy. Recently, partial adrenalectomy is a routine surgical procedure for bilateral lesions and also becoming common for unilateral lesions. We aimed to present short-term results for patients who undergo laparoscopic total or partial adrenalectomy.Material and Method: We collect data retrospectively for 33 patients who were operated on in our clinic for adrenal mass between January 2010 and December 2014. 3 patients were excluded from the study. All data were gained from personal patient medical records. Follow-up records were noted with one-by-one interviews by questioning steroid usage and symptoms of adrenal insufficiency.Results: Patients were divided into two groups as total adrenalectomy group with 19 patients and partial adrenalectomy group with 11 patients. All patients who underwent total adrenalectomy have unilateral lesions, while 4 for 11 partial adrenalectomy patients have bilateral adrenal masses. Adrenal insufficiency developed in 3 patients for total adrenalectomy, 1 patient for unilateral partial adrenalectomy, and 1 patient for bilateral partial adrenalectomy.Conclusion: Partial adrenalectomy appears to be protective for adrenal insufficiency for bilateral cases with a ratio of 75%. there was no significant difference between the total or partial unilateral adrenalectomy group, considering postoperative complications, recurrence rates, and insufficiency. As a result, laparoscopic partial adrenalectomy has similar results with less morbidity for unilateral lesions and an alternative method with less adrenal insufficiency for bilateral lesions. Laparoscopic partial adrenalectomy could be performed safely after the learning period was completed and should be considered for adrenal surgeries., Amaç: Adrenal kitleler fonksiyonel ve 4 cm üzerindeyse ilk tercih adrenalektomidir. Günümüzde adrenal kitlelerin cerrahisi için laparoskopi yaygın olarak kullanılmaktadır. Tarihsel olarak adrenal kitleler için total adrenalektomi uygulanmıştır. Fakat bilateral tutulumu olan feokromasitoma gibi olgular nedeniyle ilk kez parsiyel adrenalektomi gündeme gelmiştir. Günümüzde bilateral olgularda parsiyel adrenalektomi rutin olarak uygulanmakta iken tek taraflı benign lezyonlarda da uygulanması giderek yaygınlaşmaktadır. Bu çalışmada laparoskopik total ve parsiyel adrenalektomi yapmış olduğumuz olguları kısa dönem sonuçlarını sunmayı amaçlıyoruz.Gereç ve Yöntem: Çalışma Ocak 2010-Aralık 2014 tarihleri arasında adrenal kitle nedenli opere edilen hastaların verileri retrospektif olarak taranması ile yapılmıştır. Belitilen tarihler arasında 33 hastanın sürrenal adenoma nedenli ameliyata alındığı görülmüştür. Çalışmaya dahil edilme kriterlerine uymayan 3 hasta çalışma dışında bırakılmıştır. Çalışmaya dahil edilen 30 hastanın demografik verileri ve yapılan cerrrahi türü hasta dosyalarından öğrenilmiştir. Hastalar kontrole çağırılarak adrenal yetmezlik gelişip gelişmediği ve steroid replasman tedavisi alıp almadıkları sorgulanmıştır.Bulgular: Çalışmaya alınan 30 hastanın 19’u total adrenalektomi yapıldığı, 11’i parsiyel adrenalektomi yapıldığı görüldü. Total adrenalektomilerinin hepsi unilateral iken parsiyel yapılan ameliyatların 7’si unilateral parsiyel 4’ü bilateral parsiyel adrenalektomi yapılmış olduğu görüldü. Total adrenalektomi yapılan hastaların postoperatif dönemde 3’ünde adrenal yetmezlik gelişirken unilateral parsiyel ve bilateral parsiyel adrenalektomi yapılan hasta gruplarınında birer hastada adrenal yetmezlik geliştiği görüldü.Sonuçlar: Parsiyel adrenalektomi bilateral olgularda %75 oranında adrenal yetmezlikten korumuştur. Tek taraflı lezyonlarda da nüks, yetmezlik ve peroperatif komplikasyonlar açısından parsiyel ile total arasında fark yoktur. LPA öğrenme eğrisi tamamlandıktan sonra güvenle uygulanabilir. Bilateral adrenalektomi yapılan hastaların çoğunu yetmezlikten korur. Tek taraflı lezyonlarda uygulaması kolay ve hastaya bir zarar vermediği gibi muhtemel faydaları olaçağına inanıyoruz.

Item does not contain fulltext PURPOSE: Laparoscopic adrenalectomy is standard treatment for patients with unilateral aldosterone-producing adenomas, but surgeons are increasingly tempted to perform partial adrenalectomy, disregarding potential multinodularity of the adrenal. We assess the diagnostic value of endoscopic ultrasound for differentiating solitary adenomas from multinodularity by examining in-depth adrenal pathology with ex vivo 11.7 T magnetic resonance imaging and immunohistochemistry. MATERIALS AND METHODS: In 15 primary aldosteronism patients, we performed intraoperative endoscopic ultrasound, ex vivo magnetic resonance imaging and histopathological examination. Every adrenal was intraoperatively and postoperatively assessed for solitary adenomas or multinodular hyperplasia. After unblinding for ex vivo magnetic resonance imaging results a second detailed histopathological examination, including immunohistochemistry analysis with CYP11B2 (aldosterone synthase) and chemokine receptor 4 (CXCR4), a new marker for aldosterone-producing adenomas, was performed. Finally, presence of somatic mutations linked to aldosterone-producing adenomas was assessed. RESULTS: The sensitivity and specificity of endoscopic ultrasound to identify multinodularity were 46% and 50%, respectively. We found multinodular hyperplasia in 87% of adrenals with ex vivo magnetic resonance imaging combined with detailed histopathology, and 6 adrenals contained multiple CYP11B2-producing nodules. Every CYP11B2 positive nodule and 61% of CYP11B2 negative nodules showed CXCR4 staining. Finally, in 4 adrenals (27%) we found somatic mutations. In multinodular glands, only 1 nodule harbored this mutation. CONCLUSIONS: Intraoperative endoscopic ultrasound in primary aldosteronism patients has low accuracy to identify multinodularity. Ex vivo magnetic resonance imaging can serve as a tool to direct detailed histopathological examination, which frequently shows CYP11B2 production in multiple nodules. Therefore, partial adrenalectomy is inappropriate in primary aldosteronism as multiple aldosterone-producing nodules easily stay behind.

Background Determination of success after adrenal-sparing surgery for primary aldosteronism (PA) is limited by the lack of standardized definitions of outcomes. Objective To evaluate the safety and effectiveness of minimally invasive partial adrenalectomy (MIPA) for PA by comparing perioperative and functional outcomes with minimally invasive total adrenalectomy (MITA) according to the Primary Aldosteronism Surgical Outcome (PASO) criteria. Design, setting, and participants Between March 2011 and April 2020, a multicenter adrenalectomy dataset was queried for “unilateral adrenal mass, PA, MIPA (n = 29), or MITA (n = 61)”at four participating Institutions. Intervention MITA and MIPA for PA. Outcome measurements and statistical analysis Differences between continuous variables were assessed with the Wilcoxon rank sum test, while Pearson’s χ2 test was used for categorical data. Complete, partial, and absent clinical success rates were assessed for the overall cohort and compared between groups. Results and limitations The median tumor size was significantly higher in the MITA group (4.2 vs 2.7 cm; p = 0.001), while preoperative hypertension rate was significantly higher in the MIPA series (82.8% vs 57.4%, p = 0.01). The median length of hospital stay was increased in the MITA cohort (4 vs 3 d; p = 0.038). Overall, at a median follow-up of 42 mo (interquartile range 27–54 mo), complete, partial, and absent clinical success was observed in 60%, 17.7%, and 22.3% of cases, respectively. The complete clinical success rate was higher in the MIPA group (72.4% vs 54.1%), while a partial clinical success was higher in the MITA series (23% vs 6.8%). The absence of clinical success was comparable between groups (MITA 23% vs MIPA 20.7%). Conclusions MIPA showed excellent perioperative results with a complete clinical success rate of 72.4%. Owing to the heterogeneity of the PASO criteria in the assessment of partial or absent success, the quest for a univocal definition of satisfactory clinical outcomes in the treatment of PA remains open. Patient summary We compared minimally invasive partial adrenalectomy (MIPA) and minimally invasive total adrenalectomy for the treatment of unilateral primary aldosteronism, assessing the outcomes with the Primary Aldosteronism Surgical Outcome (PASO) criteria. MIPA seems to provide comparable perioperative outcomes and midterm clinical success rates.

In this paper, we describe the surgical technique, summarize the outcomes of comparative studies, and provide updates on other advanced surgeries in laparoendoscopic single-site (LESS) adrenalectomy. A systemic literature search in the PubMed databases was performed to identify all publications related to LESS adrenalectomy. LESS adrenalectomy performed using transumbilical, transperitoneal subcostal, or retroperitoneal approaches has been demonstrated to be a safe and feasible alternative to conventional laparoscopic adrenalectomy. Its advantages include shorter hospital stay and less pain, although the longer operative time is a concern. Additional well-designed randomized control trials are required. Furthermore, LESS partial adrenalectomy and robotic-assisted single-port adrenalectomy may be the development trends of the future.

Introduction: Nowadays, the laparoscopic approach is the gold-standard technique for the treatment of benign adrenal masses, and can be performed both transabdominally or retroperitoneally...

Objectives: Standard multi-port laparoscopic adrenalectomy (LA) is considered the gold standard for benign adrenal tumors. Single-site LA has been proposed as a feasible and safe alternative because of lower invasiveness, improved cosmetics, less pain and shorter hospital stay. The objective was to evaluate and compare results of single-site transumbilical laparoendoscopic adrenalectomy with standard LA for adrenal tumors. Materials and methods: One hundred consecutive adrenalectomies from 93 patients, performed between March 2009 and June 2017, were laparoscopically excised: 59 by standard multi-port LA (group 1) and 41 by transumbilical laparoendoscopic single-site adrenalectomy (group 2). Data gathered included demographics, comorbidities, preoperative imaging, tumor characteristics, perioperative data, surgical complications, pathology and follow-up. IBM SPSS Statistics 23 software was used and p value < 0.05 was considered significant. Results: Patients of group 2 were younger (48.7 ± 13.9 versus 59.7 ± 15.1 years; p < 0.001) and had fewer comorbidities (p < 0.05). Mean tumor diameter in group 2 was lower than those of group 1 (27.52 ± 14.3 versus 47.9 ± 30.6 mm; p < 0.001). Tumor laterality did not influence the choice of technique nor the surgical morbidity. All procedures were successfully completed, although one standard LA needed conversion to open surgery. Mean operative time, hemorrhagic losses, postoperative opioid analgesic requirement and hospital stay were not statistically different between groups. Most patients in group 2 (31 patients, 85.4%) did not require drainage, compared to 14 (25.4%) patients of group 1 (p < 0.001). Patients who underwent single-site LA resumed normal diet earlier (1.0 ± 0.2 versus 1.6 ± 0.7 days; p < 0.001). There were no reoperations and no perioperative mortality. Overall mean follow-up time was 94.9 ± 3.1 months, not statiscally different between groups (p = 0.7). Conclusions: Our results revealed that transumbilical approach for laparoendoscopic single-site adrenalectomy for adrenal tumors is a feasible and safe alternative to standard laparoscopic adrenalectomy.

INTRODUCTION AND OBJECTIVES:Laparoscopic partial adrenalectomy (LPA) is performed not only in hereditary but also in sporadic diseases as well. The per-operative identification of adrenal mass marg...

Total adrenalectomy has been the standard treatment for small adrenal masses for years. In recent times, however, partial adrenalectomy and cortex-preserving strategies are gaining more importance. Therefore, we evaluated indications, techniques and outcome of partial adrenalectomy.With more small adrenal masses identified through the widespread use of imaging modalities, partial adrenalectomy and cortical-preserving strategies were applied in various indications and techniques. In all original papers published on this topic during the review period of the last 18 months, minimal invasive approaches were used with satisfying surgical and functional outcomes.There is a definitive trend towards the use of partial adrenalectomy in the treatment of small adrenal masses. In bilateral disease, steroid replacement can be avoided in most cases, whereas successful normalization of pathological endocrine levels was reported in various indications. Therefore, minimal invasive partial adrenalectomy may become the recommended standard treatment of small benign and hormonal active adrenal tumours.

Objective To present the initial clinical experience with robot-assisted partial adrenalectomy using indocyanine green dye with near-infrared fluorescence (ICG-NIRF) imaging. Methods Three consecutive patients with solitary adrenal masses with worrisome features were referred for treatment. The preoperative workup included dedicated axial imaging and adrenal function studies. All patients underwent purely robotic partial adrenalectomy with ICG-NIRF guidance. Relevant steps of the technique included a transperitoneal approach, gross identification of the adrenal gland, administration of 5 mg intravenous ICG, and finally, mass resection guided by ICG-NIRF and white light visualization in an effort to completely excise the mass while sparing uninvolved adrenal tissue. Results Robotic partial adrenalectomy was successfully performed with negative margins in all patients. All masses were hypofluorescent relative to normal adrenal tissue with ICG-NIRF and included a pheochromocytoma, lipoadenoma, and follicular lymphoid hyperplasia. Conclusion Robotic partial adrenalectomy with intraoperative ICG-NIRF is safe and feasible. The addition of ICG-NIRF may help mass identification, excision, and promote the use adrenal-sparing surgery.

Objective Bilateral adrenalectomy or unilateral adrenalectomy and contralateral partial adrenalectomy are indicated for the treatment of ACTH-independent macronodular adrenal hyperplasia. Independent of the surgical procedure, the prognosis is poor. This paper discusses a new treatment method and its efficacy for treating nodular adrenal hyperplasia. Methods We performed a retrospective review of the medical records of 12 patients operated on between January 2008 and October 2014 at the First Affiliated Hospital of Zhengzhou University. All patients were treated by laparoscopic subcutaneous transposition of a pedicled adrenal. We performed postoperative monitoring of patients including clinical symptoms and 24-hour levels of serum free and urinary free cortisol. Results All twelve patients were pathologically confirmed to have nodular adrenal hyperplasia, and were followed for an average of 45.5 months (range, 24–60 months). The clinical symptoms of all patients disappeared, and the 24-hour plasma free cortisol and urinary free cortisol levels were within the normal range. Conclusions Laparoscopic subcutaneous transposition of a pedicled adrenal is a new and effective method for treating bilateral macronodular adrenal hyperplasia, and can achieve long-term remission of Cushing’s syndrome.

Partial adrenalectomy has recently been advocated to preserve unaffected adrenal tissue during resection of pheochromocytoma.To describe a robot-assisted laparoscopic partial adrenalectomy (RALPA) technique and to report on early functional and oncologic outcomes.From 2007 to 2010, 15 RALPA were performed on 12 consecutive patients with pheochromocytoma. Follow-up data of1 yr are available on 11 procedures. Median follow-up for the entire cohort was 17.3 mo (range: 6-45).Positioning and port placement is designed for adequate reach and visualization of the upper retroperitoneum. The plane between the adrenal cortex and pheochromocytoma pseudocapsule is identified visually and with laparoscopic ultrasound. The tumor is dissected away from normal adrenal cortex, preserving normal adrenal tissue.Preoperative, perioperative, pathologic, and functional outcomes data were analyzed.Fourteen of 15 cases were completed robotically. Among 15 procedures, 4 were performed on a solitary adrenal gland. Four cases required resection of multiple tumors (up to six) with two performed in a solitary gland. The mean age of the patients was 30 yr, and the mean body mass index was 27. The mean operative time was 163 min, the median estimated blood loss was 161 ml, and the median tumor size was 2.7 cm (range: 1.3-5.5). There was one conversion to an open procedure in a patient requiring reoperation on a solitary adrenal gland. One patient who underwent RALPA on a solitary adrenal gland required postoperative steroid supplementation at last follow-up. At a median follow-up of 17.3 mo (range: 6-45), there were no recurrences or metastatic events. Study limitations include small sample size and short follow-up.RALPA for the treatment of pheochromocytoma is feasible and safe and provides encouraging functional and oncologic outcomes, even in patients with a solitary adrenal lesion or multiple ipsilateral lesions.

Purpose: We developed step-by-step standardization of left adrenalectomy using laparoendoscopic single-site surgery (LESS) and evaluated the efficacy and safety of this surgical procedure. Patients and Methods: To simplify the procedure, we used a technique that involved handling one straight operating instrument and crossing over another articulated assistant instrument intracorporeally. We classified the reciprocal positions of the two instruments into four types. The surgical procedures were divided into six steps, and we applied one of the four types of position to each step. Results: Seven patients with left adrenal tumor underwent LESS by two operators. Five received left total adrenalectomy, one left partial adrenalectomy, and one bilateral total adrenalectomy. Mean operative time was 178 minutes. Blood loss was minimal (≤50 mL), and convalescence was uneventful in all patients. Conclusions: Although there is inevitably a learning curve, LESS left adrenalectomy can be safely introduced by ...

OBJECTIVE To evaluate the outcomes and timing of intervention for adrenal-sparing surgery in patients left with a solitary adrenal remnant after bilateral adrenal surgeries. PATIENTS AND METHODS Patients were included in the study if they had undergone bilateral adrenal surgery as a treatment for phaeochromocytoma and were left with a solitary adrenal remnant. Perioperative, functional and oncological outcomes were evaluated in 21 patients who met the inclusion criteria. RESULTS There was minimal perioperative morbidity and no perioperative mortality. After a median (range) follow-up of 21 (3-143) months, there were two cases of persistent disease. Ten patients (48%) required steroid supplementation upon discharge, with four subsequently discontinuing this treatment. Patients were more likely to require steroid supplementation after surgery if they underwent simultaneous adrenalectomy and contralateral partial adrenalectomy, rather than staged procedures (86 vs 40%, P = 0.02). Patients who underwent surgery for tumours > 4 cm were more likely to require long-term steroids than patients who underwent surgery for lesions < 4 cm (75 vs 18%, P = 0.05). CONCLUSIONS Patients left with a solitary adrenal remnant after bilateral adrenal surgery have low surgical morbidity, reasonable functional outcomes and low rates of recurrence at an intermediate follow-up period. A staged approach could decrease the immediate postoperative need for steroids, and intervention before the largest tumour reaches 4 cm could decrease the rate of long-term steroid dependence.

A young woman had mild hypertension, and on evaluation, a large tumor arising from the right adrenal gland was found. The tumor was hormonally inactive. Retroperitoneoscopic partial adrenalectomy was carried out. The histopathology report described adrenocortical oncocytoma.

症例は26歳の男性. 18歳時より高血圧を指摘され, 2年前より降圧剤を内服していた.近医で両側の副腎腫瘤を指摘され,精査加療目的で当院を紹介され入院となった.両側副腎に約4cm大の腫瘤を認め,血中ノルアドレナリン,尿中ノルアドレナリン,ノルメタネフリン, VMAが高値を示し, 113I-MIBGシンチで両側副腎に一致した集積が認められたことから,両側副腎褐色細胞腫と診断した.機能温存を目的として腹腔鏡下両側副腎部分切除術を施行した.術後7日目に軽快退院し,副腎皮質ステロイド剤の内服を漸減している.近年,副腎褐色細胞腫に対しても腹腔鏡下手術が安全に施行できるようになってきた.しかし,両側副腎褐色細胞腫に対して一期的に施行された報告は少ない.副腎機能を温存すべく,鏡視下手術の利点を生かした両側副腎の部分切除術を施行し,良好な経過を得たので,若干の文献的考察を加えて報告する.

Objectives: We evaluated posterior retroperitoneoscopic partial adrenalectomy with regard to operative complications, operation time, intraoperative blood loss. Patients and Methods: Between January 1997 and April 2002, we performed 47 posterior retroperitoneoscopic partial adrenalectomies. There were 18 males and 29 females with a mean age of 48 years (range 28–82 years). The average adrenal tumor size was 26 mm (range 10–50 mm). All procedures required three trocars. Results: There was no mortality and conversion rate to open surgery was 2.1%. Average operative time and average blood loss was 198.0 ml (range 71–420 ml) and 40.8 ml (range 0–1100 ml), respectively. There was a significant correlation of operative time with the number of procedures performed. However, no significant correlation was observed between intraoperative blood loss and the number of procedures. Tumor size did not correlate with intraoperative blood loss and operative time. No significant correlation was found between body mass index and operative time. The operative time in the initial 20 cases was significantly longer than that in the subsequent 26 cases. Conclusion: Posterior retroperitoneoscopic partial adrenalectomy is a safe and less invasive method for treatment of adrenal tumors. With improved operative technique, the time required for this procedure has been decreased.

Robotic-assisted adrenalectomy is an increasingly used intervention for patients with a variety of surgical adrenal lesions, including adenomas, aldosteronomas, pheochromocytomas, and metastases to the adrenal gland. Compared with traditional laparoscopy, robotic adrenalectomy has comparable perioperative outcomes and is associated with improved hospital length of stay and blood loss, though it does come at a cost premium. Emerging literature also supports a role for robotics in partial adrenalectomy and metastasectomy. Ultimately, well-conducted prospective trials are needed to fully define the role of robotics in the surgical management of adrenal disease.

To evaluate the effect of adrenal surgery on blood pressure (BP) in patients with both nonfunctional adrenal adenoma (NFA) and hypertension and to assess factors affecting hypertension outcomes after surgery. Nonfunctional adrenal adenoma patients with hypertension who were treated with or without adrenal surgery at our center during 2005–2011 were retrospectively studied. Clinical characteristics were collected, and changes in BP were evaluated and compared at 2 year after discharge. Factors predicting favorable hypertension outcomes after surgery were determined using logistic regression. A total of 186 patients, including 77 surgically treated cases, were eligible for this study. Retroperitoneoscopic procedure was mostly adopted, and partial adrenalectomy was performed in 69 patients. At 2 year postoperatively, both systolic and diastolic pressure levels of the surgery group decreased significantly (162.9/97.6 vs. 146.9/88.2 mmHg), with 27 (35 %) patients cured and 26 (31 %) improved. In contrast, BP levels of conservatively treated patients remained relatively stable (159.9/96.8 vs. 161.9/97.4 mmHg) after 2 years. Multivariate logistic regression analyses showed hypertension duration

Most adrenal tumors are found incidentally and appear as small solitary nodules on abdominal imaging. Occasionally, work-up demonstrates multifocal or bilateral adrenal tumors. Certain patients are predisposed to multiple lesions, such as those with hereditary forms of pheochromocytoma as seen in von Hippel-Lindau disease, multiple endocrine neoplasia type II, and von Recklinghausen's disease. Partial rather than total adrenalectomy should be considered for these patients in an attempt to preserve endogenous adrenocortical function. Partial adrenalectomy has also been used to resect other types of adrenal tumors, especially in patients with a solitary adrenal gland. A discussion of the indications for partial adrenalectomy and of the surgical technique follows.

In adults, increasing numbers of adrenalectomies for pheochromocytomas are performed laparoscopically. We report for the first time laparoscopic bilateral subtotal adrenalectomy for pheochromocytomas in an 8-year-old boy with von Hippel-Lindau disease.In July 1998, an 8-year-old boy with von Hippel-Lindau disease underwent laparoscopic adrenal-sparing surgery for bilateral pheochromocytomas. The boy presented with severe hypertension and two pheochromocytomas on both sides.The child could be solely treated with laparoscopic adrenal-sparing surgery. The procedure was completed as planned. There were absolutely no intraoperative or postoperative complications. Postoperatively, catecholamine levels and hypertension went back to normal. At follow-up no residual tumor could be detected and no steroid replacement therapy was necessary.In experienced hands, laparoscopic adrenal-sparing surgery for pheochromocytomas is feasible and safe. Moreover, this minimal invasive approach represents an exceptional improvement in life quality, especially in children with von Hippel-Lindau disease since surgery will probably be necessary again and again in their future life.

Small hormone-active benign tumors are considered as clear indication for laparoscopic adrenalectomy. Laparoscopy resection of pheochromocytomas is still a controversial issue, but recent data have shown that the specific risks of pheochromocytoma surgery are not increased by the laparascopic approach. The majority of endoscopic adrenalectomies are performed via the transperitoneal route, but there is growing interest in the retroperitoneoscopic approach. The advantages and disadvantages of each endoscopic approach have to be weighed carefully, but the final decision will also depend on the experience of the surgeon. Several retrospective studies have compared laparoscopy with open surgery. There is general agreement that laparoscopy is superior to open surgery since it is associated with less pain, a shorter hospital stay, and more rapid return to normal activities, and also yields the best cosmetic and long-term results. Partial adrenalectomy may be indicated for bilateral pheochromocytoma, and also has advantages for patients with aldosterone-producing adenomas. The feasibility of laparoscopic partial adrenalectomy has been demonstrated. Laparoscopic intraoperative ultrasonography is valuable in selected cases. The already low morbidity of laparoscopic adrenalectomy can be reduced further by using needlescopic techniques.