Laparoscopic Left Adrenalectomy for Large Pheocromocytoma with Operative Steps

Laparoscopic left adrenalectomy for large pheocromocytoma performed by Dr. Lucian Mocan at 3-rd Surgery Clinic Cluj Napoca Romania. Pheochromocytoma is a clinically important disorder as its high morbidity and mortality rate if left untreated. Tumor removal is the mainstay treatment For tumor larger than 3 cm a pheochromocytoma must be considered; adrenalectomy may be appropriate even in the context of normal biochemical study results, since it will prevent severe complications. This is a presentation of a 62-year-old women with a history of chronic left ventricular insufficiency and familial hypercholesterolemia received a speciality exam at Endocrinology Clinic in Cluj-Napoca for an adrenal incidentaloma (adrenal mass discovered incidentally during a routine ultrasound examination in another hospital showing a hypoechoic lesion, approx 6 cm in diameter, in the left adrenal gland.) She denied headache, palpitations, fever, excessive sweating, and history of hypertension. On admission, his blood pressure was 121/64 mm Hg with regular heart beats of 88 /min. Physical exam showed pale conjunctivae; other findings were unremarkable. On laboratory surveys, the blood, renal and liver function tests as well as serum electrolytes were within normal limits. A CT scanning for the adrenal glands revealed a heterogeneous, well-vascularized tumor, with regular margin and 6,7 x 5,4 x cm in size, over the left adrenal gland. Her chest CT showed unremarkable findings. The right adrenal gland as well as other intra-abdominal organs appeared to be normal. By the characteristics of the images, combined with biochemical values benign adrenal adenoma was suspected. Then, she was admitted to our hospital. Laparoscopic left adrenalectomy was performed in concern of this diagnosis. A yellowish nodule over medial limb of the right adrenal gland was found. Transient, severe hypertension (260/170 mm Hg) was detected in the course of surgery (during the dissection of adrenal vein). Pathological study confirmed the diagnosis of pheochromocytoma. During hospitalization, her blood pressure levels were 100-128 mm Hg (systolic) and 48-97 mm Hg (diastolic) with support of 8ml noradrenaline/24 hrs on ICU during the first 48 hrs. She was discharged in the 5-th postoperative day