Ömer Faruk KARATAŞ, Önder SÜRGİT, Ömer BAYRAK, AKİF KOÇ, Gökhan AKKURT, Ersin ÇİMENTEPE, DOĞAN ÜNAL

Laparoskopik adrenalektomi: Beş hasta ile ilk deneyimlerimiz

Laparoskopik adrenalektomi birçok adrenal hastalıkta standart tedavi yöntemi olarak açık cerrahinin yerini almıştır. Bu klinik çalışmamızda ilk 5 laparoskopik adrenalektomi vakalarımız sunulmaktadır. Ocak ve Nisan 2008 tarihleri arasında 5 hastaya transpe-ritoneal yol ile standart laparoskopik adrenalektomi uygulandı. Preoperatif olarak tüm adrenal kitleler abdo-minal ultrasonografi ve abdominal bilgisayarlı tomografi ile görüntülendi. Hastaların kanlarında serum dopamin, ACTH, aldosteron, kortizol, epinefrin, norepinefrin sevi-yeleri ve 24 saatlik idrarlarında 5-HIAA, metanefrin, homovalinik asit, vanil mandelik asit, adrenalin ve noradrenalin düzeyleri ölçüldü. Hastalardan 3’ünde feok- romasitoma, 1 hastada adrenal adenom ve 1 hastada böbrek tümörünün kontrlateral adrenale metastazı tanısı ile adrenalektomi endikasyonu konuldu. Laparoskopik adrenalektominin cerrahi parametreleri ve fonksiyonel kısa dönem sonuçları bu çalışmada bildirildi. Adrenal kitlelerden 3 tanesi sağda, 2 tanesi solda bulu-nuyordu. Hastaların 3’ü bayan, 2’si erkek olup yaş ortalamaları 60,5 (38-64) idi. Operasyon süresi ortalama 115 (100-120) dakika olarak kaydedildi. Ortalama kana-ma miktarı 90 ml olarak saptandı. Postoperatif 1. gün tüm hastalar taburcu edildi. Hastaların hiçbirine transfüzyon uygulanmadı. Hastalarda komplikasyon gelişmedi ve açık cerrahiye dönülmedi. İlk beş olgu eşliğindeki sınırlı sayı ile elde ettiğimiz veriler göstermektedir ki, transperitoneal yaklaşımla uygulanan laparoskopik adrenalektomi üroloji pratiğinde uygulanabilir bir yöntemdir. Laparoskopik adrenalektomi sonrası uzun dönem sonuçlarının ortaya konması ve vaka sayısının artması ile daha güvenilir bilgiler elde edilebilecektir.

Laparoscopic adrenalectomy: Our first experiences with five patients

Laparoscopic adrenalectomy as standard treatment method for adrenal diseases has taken the place of open surgery. The first 5 cases of laparoscopic adrenalectomy have been presented in this study. The standard transperitoneal laparoscopic adrenalectomy was performed in 5 patients between January–April 2008. All adrenal masses had been shown preoperatively by abdominal ultrasonography and computed tomography. Serum dopamin, ACTH, aldosteron, cortisol, epinefrin, norepinefrin levels were measured in blood tests and urinary metabolites (5-HIAA, metanefrin, homovalinic acide, vanil mandelik acide, adrenalin and noradrenalin) were measured in 24 hours urine tests. The posto-perative pathological diagnoses were pheocromacytoma in 3 patients, adrenal adenoma in 1 patient and contra-lateral kidney tumor metastasis in 1 patient. The results of laparascopic adrenalectomy (surgical parameters and short-time results) were reported in this study. The 3 adrenal masses were in right side and 2 were in left side. Three patients were women and 2 patients were men and mean age was 60.5 (38-64) years. Mean operation time was recorded as 115 (100-120) minutes. Mean bleeding volume was 90 ml. All patients were discharged in 1. postoperative day. None of the patients required blood transfusion. There was no complication and in none of the patients was returned to the open surgery.– Obtained data with by the limited number of the first five cases showed that transperitoneal laparoscopic adrena-lectomy may be an acceptable technique in urology practice. With long-term results of laparoscopic adrenalectomy and by increasing the case number more reliable information can be obtained.

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