Adrenal (Adrenal) Pathology
Minimally Invasive Via
Posterior Retroperitonoscopy
Goal:
Treat adrenal nodules effectively, with minimal pain and rapid recovery.
What allows you to treat:
Pheochromocytoma
Primary hyperaldosteronism (Synd. Conn)
Hypercortisolism (Sind. Cushing)
All benign lesions < 6-8 cm
#adrenal #adrenal #general surgery #coimbra
Adrenal Gland (Adrenal)
The adrenal gland is an organ of the endocrine system, located bilaterally in the retroperitoneum, in close relationship with the upper pole of the kidney, surrounded by fat and Gerota's fascia, irrigated by several arteries and with venous drainage to the central venous system. It produces and releases various hormones into circulation. When there is excess production, it becomes pathological.
SUPRARENAL SURGERY
How are nodules diagnosed?
Incidental and Hypertension
ALL MUST BE STUDYED
Adrenal nodules are often found incidentally or during the study of hypertension. All adrenal nodules must be studied in order to answer two questions: Is it malignant? Is it working?
Which ones must be treated surgically?
It depends on the characteristics
FUNCTIONAL AND MALIGNANT
All functioning nodules (Pheochromocytoma, Conn's Syndrome and Cushing's Syndrome) and all malignant nodules. In the case of nodules not functioning but with more than 6 cm the decision will have to be individualized to the patient in question.
How to operate the adrenal?
Minimally Invasive Via
POSTERIOR RETROPERITONEOSCOPY
The minimally invasive route is currently the preferred approach. As the adrenal gland is a retroperitoneal organ, there is no need to use the anterior (laparoscopic) route and cross/remove intra-abdominal viscera, with the inherent risk of inadvertently damaging them, to access the gland. Therefore, the posterior retroperitoneoscopic approach is the approach that I prefer. Through three mini incisions in the back, access to the adrenal is direct, with minimal risk of injuring other viscera, effective and of quick recovery.
Are all patients candidates for the posterior retroperitoneoscopic approach?
not always and never
EACH PATIENT IS A PATIENT
No. It will all depend on the size of the lesions and whether or not they are malignant. Although the posterior retroperitoneoscopic approach is preferable, sometimes the open route (laparotomy) is the best option.
Can complications occur?
yes but they are rare
MINIMUM BUT POSSIBLE
The entire surgical procedure is accompanied by possible complications. Both doctors and patients must be aware that even running "by the book", complications can occur. These can be intraoperative or postoperative. However, the retroperitoneoscopic route has low morbidity.
