Walz Aldosteronoma

Excerpt

In their article in this issue, Walz and colleagues (DOI:10.​1007/​s00268-007-9513-0) report their experience with surgical treatment of hyperaldosteronism caused by an adrenocortical adenoma or nodular hyperplasia. All 183 patients underwent surgery via a posterior retroperitoneoscopic approach. Dr. Walz has refined this alternative minimally invasive approach to adrenalectomy by standardizing port placement, using higher than customary insufflation pressures, and applying a structured dissection technique. These advances have made retroperitoneoscopic adrenalectomy a practical alternative to the traditional anterior transperitoneal approach. The retroperitoneoscopic approach is anatomically more direct than the anterior approach, requiring less dissection of adjacent organs. It has real advantages in selected patients—for example, those who have had prior open abdominal operations with resulting significant intra-abdominal adhesions. It appears to be a safe alternative for the majority of patients who would otherwise be candidates for an anterior laparoscopic approach; that is, patients with relatively small, presumably benign adrenal tumors. This includes patients with a pheochromocytoma as well as those with a functioning adrenocortical adenoma, including an aldosteronoma. Even for surgeons experienced with both techniques, transperitoneal laparoscopic adrenalectomy may still be preferred in some situations: resection of pheochromocytomas in the 6–8-cm range, for example, may still be more straightforward for most surgeons if approached using the standard anterior transperitoneal technique. …