Experience with laparoscopic adrenalectomy in children

Presented at the 35th Annual Meeting of the Canadian Association of Paediatric Surgeons, Niagara-on-the-Lake, Ontario, Canada, September 18–21, 2003.
https://doi.org/10.1016/j.jpedsurg.2004.01.043Get rights and content

Abstract

Purpose

The aim of this study was to review the authors’ experience with laparoscopic adrenalectomy in the pediatric age group.

Methods

This is a retrospective analysis of laparoscopic adrenalectomies performed in children at King Faisal Specialist Hospital & Research Centre, between June 1997 and March 2003. Ten children had laparoscopic adrenalectomies during this period. They were between 3 weeks to 12 years of age and there was an equal number of boys and girls. Case selection was based mainly on the size of the lesion and its localized nature as seen on the imaging studies. The transperitoneal approach was used in all cases.

Results

Eleven laparoscopic adrenalectomies were performed in 10 children (1 was bilateral adrenalectomy). Presenting features were virilization (n = 3), Cushing’s syndrome (n = 1), antenatally detected adrenal cyst (n = 1), hypertension (n = 1), hepatomegaly (n = 1), loin pain with hematuria (n = 1) and an incidental adrenal mass (n = 1). One was a child with stage IV adrenal neuroblastoma postchemotherapy for resection of the residual tumor. On imaging studies, the tumors were between 2.8 and 7 cm in their largest dimension. Operating time ranged from 118 to 180 minutes in the unilateral resections, whereas the bilateral laparoscopic adrenalectomy required 330 minutes. Two had to be converted to open procedures. Postoperative hospital stay was between 2 and 15 days. Pathologic diagnoses were as follows: adrenal cortical adenoma (n = 3), adrenal medullary hyperplasia (n = 2), adrenal cortical carcinoma (n = 1), ganglioneuroma (n = 1), and neuroblastoma (n = 3). There were no complications. Follow-up ranged from 3 months to 6 years. The only mortality in our study group was in the child with stage IV neuroblastoma who died of disseminated disease 9 months later. In the rest, there has been no local recurrence or metastases, and the biochemical and hormonal parameters have remained normal in the functional tumors.

Conclusions

We believe that in a select group of pediatric adrenal lesions, laparoscopic adrenalectomy is a safe and effective procedure with the potential benefits of minimally invasive procedures.

Section snippets

Materials and methods

We reviewed retrospectively 11 consecutive laparoscopic adrenalectomies performed in 10 children at our institution between June 1997 and March 2003. The medical records of all the patients were reviewed and the data collected were patient age and sex, preoperative diagnosis, location and size of the lesion, operating time, conversion to open procedure, blood loss, postoperative hospital stay, complications, pathologic diagnosis, and follow-up.

A thorough preoperative evaluation was carried out

Results

Ten children had laparoscopic adrenalectomies during the period from June 1997 to March 2003. Their mean age was 4 years (range, 3 weeks to 12 years), with equal number of boys and girls. Their body weights were between 4.14 kg and 42 kg. Presenting features included an antenatally detected right adrenal cyst (n = 1), early onset of virilization (n = 3 – 2 isosexual and 1 heterosexual), familial Cushing’s syndrome (n = 1), hypertension (n = 1), loin pain and hematuria (n = 1), hepatomegaly with

Discussion

Although laparoscopic adrenalectomy has been shown to have potential advantages over the open procedure in adults, the experience in the pediatric age group is still limited. With the growing experience and ease of laparoscopic surgery in children, the trend today is toward the increasing use of minimally invasive procedures. Laparoscopic adrenalectomy is increasingly gaining popularity. The adrenal gland, because of its small size and its retroperitoneal location, is suitable for laparoscopic

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