Reference : L'abord coelioscopique des pheochromocytomes est-il acceptable? Reflexions a propos d'un...
Scientific journals : Article
Human health sciences : Anesthesia & intensive care
Human health sciences : Surgery
http://hdl.handle.net/2268/26751
L'abord coelioscopique des pheochromocytomes est-il acceptable? Reflexions a propos d'une etude prospective de 6 cas personnels.
French
[en] Is celioscopic approach of pheochromocytoma acceptable? Reflections apropos of a prospective study of 6 personal cases
Hamoir, Etienne mailto [Centre Hospitalier Universitaire de Liège - CHU > > Chirurgie abdominale- endocrinienne et de transplantation >]
Defechereux, Thierry [Centre Hospitalier Universitaire de Liège - CHU > > Chirurgie abdominale- endocrinienne et de transplantation >]
Nguyen Dang, Delphine [Centre Hospitalier Universitaire de Liège - CHU > > Pneumologie-Allergologie >]
Joris, Jean mailto [Centre Hospitalier Universitaire de Liège - CHU > > Anesthésie et réanimation >]
Hartstein, Gary mailto [Centre Hospitalier Universitaire de Liège - CHU > > Urgences - Anesthésie et réanimation >]
Meurisse, Michel mailto [Centre Hospitalier Universitaire de Liège - CHU > > Chirurgie abdominale- endocrinienne et de transplantation >]
1997
Annales d'Endocrinologie
Masson
58
1
65-74
Yes (verified by ORBi)
International
0003-4266
Moulineaux Cedex 9
France
[en] Adrenal Gland Neoplasms/pathology/surgery ; Adult ; Aged ; Anesthesia, General/methods ; Catecholamines/blood ; Female ; Hemodynamics ; Humans ; Intraoperative Period ; Laparoscopy/methods ; Male ; Pheochromocytoma/pathology/surgery ; Postoperative Period ; Prospective Studies
[en] Today, laparoscopy is for us the technique of choice for approaching presumed benign adrenal tumors. With regards to pheochromocytoma however, two major questions must be addressed. First, is it acceptable to resect potentially multifocal tumors with such a targeted approach? Second, can peroperative hemodynamic changes be anticipated and controlled by the anesthetist, taking into account the additional effects of pneumoperitoneum and catecholamine release on the cardiovascular system? The present prospective study attempts to answer these two questions. From November 1993 to November 1995 we operated on four women and two men, with ages ranging from 33 to 71 years (mean of 47) and a mean Body Mass Index of 25 kg/m2 (range 17-35). Four patients were assigned ASA (American Society of Anesthesiologists) physical status 2, one grade 1 and one grade 3. Comprehensive preoperative work-up, including a CT scan and an I131 MIBG Scan in all, a C11 Hydroxyephedrine PET Scan in 4 and a MRI in one patient, showed a solitary lesion in each case. There were four right-sided and two left-sided tumors, ranging from 30 to 60 mm in diameter. Laparoscopy was always performed transperitoneally. Systemic and pulmonary hemodynamics were thoroughly assessed. Epinephrin and norepinephrin concentrations were measured at the 10 key-time of surgery. Use of continuous intravenous infusion of nicardipine allowed tight control of hemodynamics despite impressive increases in circulating catecholamines. The mean operative time was 76 minutes (range 59-130). Blood loss was minimal. We observed neither mortality nor morbidity. Mean hospital stay ranged from 3 to 13 days (median = 3). All patients are normotensive without drug after a follow-up of 9 to 33 months. In conclusion, we think that laparoscopic removal of selected cases of pheochromocytoma may be performed safely from both the hemodynamical and oncological standpoints.
http://hdl.handle.net/2268/26751
also: http://hdl.handle.net/2268/94440

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