Comparison of the Hemodynamic Parameters of Open and Laparoscopic Adrenalectomy for Pheochromocytoma

World Journal of Surgery - Tập 24 Số 5 - Trang 574-578 - 2000
William B. Inabnet1, J Pitre2, Bernard Denis3, Y Chapuis2
1Department of General Surgery, Mount Sinai Medical Center, 5 East 98th Street, Box 1259, New York, New York 10028, USA
2Department of General Surgery Cochin Hospital CHU Cochin‐Port Royal, 27, rue de Fg. St. Jacques 75674 Paris France<!--<country1>FR</country1>-->
3Department of Anesthesia Cochin Hospital CHU Cochin‐Port Royal, 27, rue de Fg. St. Jacques, 75674 Paris France<!--<country1>FR</country1>-->

Tóm tắt

Abstract.Laparoscopic adrenalectomy has gained widespread popularity for treating a variety of adrenal disorders including pheochromocytoma, but the effects of pneumoperitoneum on the hemodynamics of patients with catecholamine‐secreting tumors are poorly understood. The goal of this study was to compare the effects of carbon dioxide pneumoperitoneum and tumor manipulation on the hemodynamic parameters in two groups of patients with sporadic pheochromocytomas less than 7 cm in size. Group 1 patients (n= 11) underwent lateral transabdominal laparoscopic adrenalectomy, and group 2 (n= 11) underwent adrenalectomy by the open anterior approach. The mean follow‐up was 37 months in group 1 (range 26–51 months) and 52 months in group 2 (range 27–72 months). All patients undergoing laparoscopic adrenalectomy experienced intraoperative hypertension (blood pressure ≥200/90 mmHg), as did 73% with the open approach, but the difference was not significantly different. Intraoperative hypotension (systolic blood pressure < 80 mmHg) occurred in four group 1 patients compared to six patients in group 2. Mean arterial pressure, central venous pressure, and pulmonary capillary wedge pressure were significantly higher in group 1 patients prior to tumor excision, but there was no difference in pulse, cardiac index, or left ventricle work index at any point during the procedure. There were no conversions or complications in the laparoscopic group; one patient in group 2 developed an incisional hernia. Although laparoscopic adrenalectomy for pheochromocytoma is associated with a greater increase in mean arterial pressure, central venous pressure, and pulmonary capillary wedge pressure, the creation of pneumoperitoneum does not significantly change the cardiac index or left ventricle work index. Carbon dioxide pneumoperitoneum is well tolerated in patients with pheochromocytoma.

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World Journal of Surgery

Tập 24 Số 5

574-578

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