V1115 THE ANTERIOR APPROACH TO RETROPERITONEOSCOPIC ADRENALECTOMY IN CHILDREN

You have accessJournal of UrologyPediatrics1 Apr 2010V1115 THE ANTERIOR APPROACH TO RETROPERITONEOSCOPIC ADRENALECTOMY IN CHILDREN Waleed Eassa, Roman Jednak, Mohamed El Sherbiny, and John Paul Capolicchio Waleed EassaWaleed Eassa More articles by this author , Roman JednakRoman Jednak More articles by this author , Mohamed El SherbinyMohamed El Sherbiny More articles by this author , and John Paul CapolicchioJohn Paul Capolicchio More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2312AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Very limited literature exists on minimally invasive techniques for adrenalectomy in children. Retroperitoneal adrenalectomy (RPA) has the potential advantage of avoiding intra-abdominal organ retraction but, concerns have been expressed with the lateral RPA on the right side. Zhang et al. (J Urol. April 2007) have described a novel anterior RPA approach which appears to overcome the limitations of the lateral approach. Herein, we describe the second reported experience with the anterior approach to RPA in children. METHODS Two children, aged 8 and 14 years old, presented with incidentally discovered right adrenal masses measuring 7x5x4 cm and 5x4x4 cm on magnetic resonance imaging. Both patients were placed in the lateral decubitus position with lumbar hyperextension. A 5mm, 3-port approach was used. The retroperitoneal space outside Gerota's fascia is developed under direct vision, from the common iliacs up to the diaphragm. The first fascial plane of dissection is developed anterior to the upper pole of the kidney thus revealing the anterior surface of the adrenal. The second plane of exposure is the inferior surface of the adrenal followed by medial exposure of the vena cava and adrenal vein. After division of the adrenal vein the remaining superior attachments which were suspending the gland are divided. Since the adrenal is suspended by its superior attachments throughout, no manipulation of the gland is required (no touch technique). The posterior port is extended to permit intact retrieval of the specimen with an entrapment sac. RESULTS Pathology revealed a 7cm, 60 gm ganglioneuroma in the first patient and a 5 cm, 40 gm pheochromocytoma in the second, with intact surgical margins in both cases. Operative time with these large masses and first experience with this technique was 5 hours in the first case and 3.5 hours in the second, with the trainee performing most of the second case. No intraoperative or postoperative complications were noted, with minimal blood loss and a hospital stay of 36 hours in both cases. No intra-operative hypertension was noted in the patient with pheochromocytoma who had pre-operative pharmacologic alpha and beta blockade. CONCLUSIONS The anterior approach to right RPA is feasible even in children with a smaller retroperitoneal space and a large adrenal mass. It seems to provide superior exposure of the adrenal gland and vein compared to the lateral RP approach, as suggested by Zhang et al. in their experience with 800 cases in adults. Montreal, Canada© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e432 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.Metrics Author Information Waleed Eassa More articles by this author Roman Jednak More articles by this author Mohamed El Sherbiny More articles by this author John Paul Capolicchio More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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