Single-Incision Transperitoneal Laparoscopic Left Adrenalectomy

Posted on March 24, 2012 by MaryO

Óscar Vidal, Emiliano Astudillo, Mauro Valentini, Cesar Ginestà, Juan C. García-Valdecasas and Laureano Fernandez-Cruz

 

 

Abstract

Background  

Laparoscopic adrenalectomy via three or four trocars is a well-established procedure. This report describes the initial experience with single-incision laparoscopic surgery (SILS) using the transperitoneal approach for left adrenalectomy.

Methods

Between April 2010 and August 2011, all consecutive patients with adrenal masses, including Conn’s syndrome, Cushing’s adenoma, and nonfunctional adrenal tumors, who agreed to undergo SILS adrenalectomy were included in a prospective study. The left 2.5-cm subcostal incision was the sole point of entry. Data of patients who underwent SILS adrenalectomy were compared with those from an uncontrolled group of patients who underwent conventional laparoscopic adrenalectomy during the same study period.

Results

There were 20 patients in each study group (20 men, 20 women; mean age [SD] = 50 [6.5] years). SILS was successfully performed and none of the patients required conversion to an open procedure. In one case of SILS procedure, an additional lateral 5-mm port was needed for retraction of the kidney. The mean (SD) duration of the operation was 95 (20) min in the SILS group and 80 (8) min in the conventional laparoscopic adrenalectomy group (p = 0.052). There were no intraoperative or postoperative complications. There were no differences between the two study groups with respect to postoperative pain, number of patients who resumed oral intake within the first 24 h, final pathologic diagnosis, and length of hospital stay.

Conclusion  

SILS left adrenalectomy is a technically feasible and safe procedure in carefully selected patients. The definitive clinical, aesthetic and functional advantages of this technique require further analysis.

 

 

 

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From http://www.springerlink.com/content/h60075322750m0x0/

 

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Retroperitoneal Adrenal-Sparing Surgery for the Treatment of Cushing’s Syndrome Caused by Adrenocortical Adenoma: 8-Year Experience With 87 Patients

Posted on March 14, 2012 by MaryO

Hong-chao He, Jun Dai, Zhou-jun Shen, Yu Zhu, Fu-kang Sun, Yuan Shao, Rong-ming Zhang, Hao-fei Wang, Wen-bin Rui and Shan Zhong

 

Abstract

Background  

The objective of this study was to present our 8-year experience with partial adrenalectomy via the retroperitoneal approach for the treatment of Cushing’s adenoma.

Methods  

A total of 93 patients who underwent adrenal surgery for Cushing’s adenoma from March 2003 to December 2010 were enrolled in this study. Preoperative, intraoperative, and postoperative variables were reviewed from the database. Student’s t test was used to analyze the continuous data, and the χ2 test was used to analyze the categoric data. A value of p < 0.05 was considered statistically significant.

Results  

Adrenal-sparing surgery was performed in 87 cases (31 by open surgery, 56 by retroperitoneal laparoscopy). Six patients underwent open/laparoscopic total adrenalectomy because of recurrent disease or a large size. The cure rate in our series was 97.8%. Hypertension resolved in 34 of 64 patients (53.1%), diabetes in 7 of 27 patients (25.9%) and obesity in 28 of 48 patients (58.3%). One patient died during the postoperative period. The intraoperative complication rate for the open surgery group was significantly higher than that for the retroperitoneal laparoscopy group (9.1 vs. 1.7%).

Conclusions  

The retroperitoneal approach is reliable and safe for treating Cushing’s syndrome. The laparoscopic technique can decrease the prevalence of intraoperative complications. Retroperitoneal laparoscopic partial adrenalectomy can be performed with extremely low morbidity and achieves an excellent outcome, although death may occur during the postoperative period in high-risk patients. Postoperative management plays an important role in the surgical treatment of Cushing’s syndrome.

 

Jun Dai is listed as co-first author.

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From http://www.springerlink.com/content/034754537j7586k2/

 

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The Adrenal Vein Sampling International Study (AVIS) for Identifying the Major Subtypes of Primary Aldosteronism

Posted on March 13, 2012 by MaryO
  1. Gian Paolo Rossi, 
  2. Marlena Barisa, 
  3. Bruno Allolio, 
  4. Richard J. Auchus, 
  5. Laurence Amar,
  6. Debbie Cohen, 
  7. Christoph Degenhart, 
  8. Jaap Deinum, 
  9. Evelyn Fischer, 
  10. Richard Gordon,
  11. Ralph Kickuth, 
  12. Gregory Kline, 
  13. Andre Lacroix, 
  14. Steven Magill, 
  15. Diego Miotto,
  16. Mitsuhide Naruse, 
  17. Tetsuo Nishikawa, 
  18. Masao Omura, 
  19. Eduardo Pimenta,
  20. Pierre-François Plouin, 
  21. Marcus Quinkler, 
  22. Martin Reincke, 
  23. Ermanno Rossi,
  24. Lars Christian Rump, 
  25. Fumitoshi Satoh, 
  26. Leo Schultze Kool, 
  27. Teresa Maria Seccia,
  28. Michael Stowasser, 
  29. Akiyo Tanabe, 
  30. Scott Trerotola, 
  31. Oliver Vonend, 
  32. Jiri Widimsky Jr.,
  33. Kwan-Dun Wu, 
  34. Vin-Cent Wu and 
  35. Achille Cesare Pessina

–Author Affiliations


  1. University of Padova (G.P.R., M.B., T.M.S., A.C.P.), Department of Medicine (DIMED) Internal Medicine 4, Padova, 35128 Italy; University Hospital Würzburg (B.A.), Department of Internal Medicine I, Endocrine and Diabetes Unit, Würzburg, 97080 Germany; University of Texas (R.J.A.), Southwestern Medical Center at Dallas, Dallas, Texas 75390; Hôpital Européen Georges Pompidou (L.A., P.-F.P.), Hypertension Unit, Paris, 75908 France; Hospital of The University of Pennsylvania (D.C.), Department of Internal Medicine, Philadelphia, Pennsylvania 19104; University Hospital Innenstadt (C.D.), Department of Clinical Radiology, Munich, 80336 Germany; Radboud University Nijmegen (J.D.), Department of Internal Medicine, Nijmegen, 6225GA Netherlands; University Hospital Innenstadt (E.F., M.R.), Department of Endocrinology, Munich, Germany; University of Queensland School of Medicine (R.G., E.P., M.S.), Greenslopes Hospital, Endocrine Hypertension Research Centre, Brisbane, 4120 Australia; University Hospital Würzburg (R.K.), Institute of Radiology, Würzburg, Germany; University of Calgary (G.K.), Foothills Medical Centre, Calgary, T2N4J8 Canada; Centre hospitalier de l’Université de Montréal (A.L.), Department of Medicine, Montreal, H2W 1T8 Canada; Medical College of Wisconsin (S.M.), Endocrinology Clinic Community Memorial Medical Commons, Menomonee Falls, Wisconsin 53051; University of Padova (D.M.), Department of Medicine (DIMED) Radiology, Padova, Italy; National Hospital Organization Kyoto Medical Center (M.N.), Department of Endocrinology Clinical Research Institute, Kyoto, 612-8555 Japan; Yokohama Rosai Hospital (T.N., M.O.), Department of Endocrinology and Metabolism, Yokohama City, 222-0036 Japan; Clinical Endocrinology (M.Q.), Charité Campus Mitte, Charité University Medicine Berlin, Berlin, 10117 Germany; Azienda Ospedaliera Santa Maria Nuova (E.R.), Department of Internal Medicine, Reggio Emilia, 42123 Italy; Department of Nephrology (L.C.R., O.V.), Heinrich-Heine-University Düsseldorf, Düsseldorf, 40225 Germany; Tohoku University Hospital (F.S.), Department of Nephrology, Endocrinology and Vascular Medicine, Sendai, 980-8574 Japan; Department of Radiology (L.S.K.), Radboud University Nijmegen Medical Center, Nijmegen, Netherlands; Institute of Clinical Endocrinology (A.T.), Tokyo Women’s Medical University, Tokyo, 162-8666 Japan; Hospital of The University of Pennsylvania (S.T.), Department of Radiology, Philadelphia, Pennsylvania; Charles University in Prague (J.W.), General Faculty Hospital, Third Department of Medicine, Prague, 12808 Czech Republic; and National Taiwan University Hospital (K.-D.W., V.-C.W.), Department of Internal Medicine, Taipei, 10048 Taiwan
  1. Address all correspondence and requests for reprints to: Prof. Gian Paolo Rossi, M.D., FACC, FAHA, Department of Medicine, Internal Medicine 4, University Hospital via Giustiniani, 2, 35126 Padova, Italy. E-mail: gianpaolo.rossi@unipd.it.

 

Abstract

Context: In patients who seek surgical cure of primary aldosteronism (PA), The Endocrine Society Guidelines recommend the use of adrenal vein sampling (AVS), which is invasive, technically challenging, difficult to interpret, and commonly held to be risky.

Objective: The aim of this study was to determine the complication rate of AVS and the ways in which it is performed and interpreted at major referral centers.

Design and Settings: The Adrenal Vein Sampling International Study is an observational, retrospective, multicenter study conducted at major referral centers for endocrine hypertension worldwide.

Participants: Eligible centers were identified from those that had published on PA and/or AVS in the last decade.

Main Outcome Measure: The protocols, interpretation, and costs of AVS were measured, as well as the rate of adrenal vein rupture and the rate of use of AVS.

Results: Twenty of 24 eligible centers from Asia, Australia, North America, and Europe participated and provided information on 2604 AVS studies over a 6-yr period. The percentage of PA patients systematically submitted to AVS was 77% (median; 19–100%, range). Thirteen of the 20 centers used sequential catheterization, and seven used bilaterally simultaneous catheterization; cosyntropin stimulation was used in 11 centers. The overall rate of adrenal vein rupture was 0.61%. It correlated directly with the number of AVS performed at a particular center (P = 0.002) and inversely with the number of AVS performed by each radiologist (P = 0.007).

Conclusions: Despite carrying a minimal risk of adrenal vein rupture and at variance with the guidelines, AVS is not used systematically at major referral centers worldwide. These findings represent an argument for defining guidelines for this clinically important but technically demanding procedure.

  • Received October 14, 2011.
  • Accepted January 31, 2012.
  • Copyright © 2012 by The Endocrine Society

From http://jcem.endojournals.org/content/early/2012/03/01/jc.2011-2830.abstract?rss=1

 

 

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Adrenal Crisis

Posted on February 26, 2012 by MaryO

This is a “knol” that I wrote in 2008.  It was accepted by the Open Journal of Medicine.  

Now that “knols” are being discontinued, the Open Journal moved this to their site but all of the images were lost in the move.  Also, the name of one of their authors was added to my knol.  

I’m posting this here to keep the information as it was, not as it has morphed into.

Addison’s_Disease.pdf Download this file

 

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New Endocrinology App

Posted on February 6, 2012 by MaryO

[prMac.com] South Dartmouth, Massachusetts – The Editors of Endotext and Thyroidmanager announce the release of their new medical app, “Endocrinology and Endo Emergency”.

The app provides concise, practical information on endocrine emergencies, and provides the answers needed RIGHT NOW for their care. Each of the 36 topics covered includes the clinical recognition, pathophysiology, diagnosis, differential, treatment, and follow up. In addition, references to available Clinical Guidelines, and important literature citations are provided.

Focusing on the critical information needed at the point of care, the app includes topics such as Cushing’s disease, diabetic ketoacidosis, managing acute type I and type II diabetes, hypercholesterolemia, adrenal insufficiency, hyperthyroidism, thyroid storm, and much more. Key facts are presented in tables and flow-charts to allow quick reference to crucial information.

The app is designed for physicians, nurses, emergency room caregivers, hospitalists, trainees, students, and any caregiver who needs to treat seriously ill patients.

The “Endocrinology and Endo Emergency” mobile application was created by the world-renowned endocrinologists who also brought you ENDOTEXT.ORG and THYROIDMANAGER.ORG, the most comprehensive and up-to-date web-based endocrine textbooks. Endocrinology and Endo Emergency is always updated with the latest information, and updates can be automatically downloaded by users.

To view or purchase the app in the Apple App store (also available for android) or go to endoemergencies website for information and to view a sample section. Qualified reviewers may contact us for promo codes.

* Covers endocrinology and endocrine emergencies

* Provides critical information needed at the point of care

* 36 topics covered

* written by expert endocrinologists from around the world

Device Requirements:
* iPhone 3GS, iPhone 4, iPhone 4S, iPod touch (3rd generation), iPod touch (4th generation) and iPad
* Requires iOS 5.0 or later
* 1.7 MB

 

Pricing and Availability:
Endocrinology & Endo Emergency 1.0 is $5.99 USD (or equivalent amount in other currencies) and available worldwide exclusively through the App Store in the Medical category.

Endocrine Emergencies
Thyroid Disease Manager
Endotext Web Book
Purchase and Download
Screenshot
App Icon

Produced and owned by Endocrine Education, Inc. and Mdtext.Com, Inc. Copyright (C) 2012 Endocrine Education, Inc. and Mdtext.Com, Inc. All Rights Reserved. Apple, the Apple logo, iPhone, iPod and iPad are registered trademarks of Apple Inc. in the U.S. and/or other countries.

From http://prmac.com/release-id-38000.htm

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