Surgery of the Adrenal Gland PDF
Preview Surgery of the Adrenal Gland
Surgery of the Adrenal Gland Andrea Valeri Carlo Bergamini • Rocco Bellantone Celestino Pio Lombardi • Editors Surgery of the Adrenal Gland 123 Editors Andrea Valeri Rocco Bellantone Chirurgia Generale Istitutodi Semeiotica Chirurgica d’Urgenzae Mininvasiva PoliclinicoGemelli OspedaleCareggi Rome Florence Italy Italy Celestino Pio Lombardi Istitutodi Semeiotica Chirurgica CarloBergamini PoliclinicoGemelli Chirurgia Generale Rome d’Urgenzae Mininvasiva Italy OspedaleCareggi Florence Italy ISBN 978-88-470-2585-1 ISBN 978-88-470-2586-8 (eBook) DOI 10.1007/978-88-470-2586-8 SpringerMilanHeidelbergNewYorkDordrechtLondon LibraryofCongressControlNumber:2012942021 (cid:2)Springer-VerlagItalia2013 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpartof the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,broadcasting,reproductiononmicrofilmsorinanyotherphysicalway,andtransmissionor informationstorageandretrieval,electronicadaptation,computersoftware,orbysimilarordissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purposeofbeingenteredandexecutedonacomputersystem,forexclusiveusebythepurchaserof thework.Duplicationofthispublicationorpartsthereofispermittedonlyundertheprovisionsofthe CopyrightLawofthePublisher’slocation,initscurrentversion,andpermissionforusemustalwaysbe obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright ClearanceCenter.ViolationsareliabletoprosecutionundertherespectiveCopyrightLaw. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publicationdoesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexempt fromtherelevantprotectivelawsandregulationsandthereforefreeforgeneraluse. While the advice and information in this book are believed to be true and accurate at the date of publication,neithertheauthorsnortheeditorsnorthepublishercanacceptanylegalresponsibilityfor anyerrorsoromissionsthatmaybemade.Thepublishermakesnowarranty,expressorimplied,with respecttothematerialcontainedherein. Printedonacid-freepaper SpringerispartofSpringerScience+BusinessMedia(www.springer.com) Preface Laparoscopy is undoubtedly a ‘‘revolution’’ in modern surgery. It has rapidly become the ideal solution for many minor and less major abdominal surgical interventions(appendectomy,cholecystectomy,etc…).Inmorerecenttimes,ithas also proved very effective for major surgery (colectomy, splenectomy, adrenal- ectomy,nephrectomy,etc.), and,inmostcases,laparoscopy seems tobethemost appropriate treatment. Withinthesphereofmajorsurgerywhichcanbeconfrontedwithlaparoscopy, adrenalectomy is undoubtedly of the utmost importance, from the historical, technical and clinical point of view. In fact, the first laparoscopic adrenalectomy was carried out by Hyshygara and Gagner as long ago as 1992, well before other major surgical interventions. The demonstration of its feasibility and reproduc- ibility has cleared the way for still more complex procedures. Currently it is the ‘‘GoldStandard’’therapyforthemajorityofadrenalglandtumorsandistherefore considered to be one of the most effective laparoscopic procedures. This statement is based on the results of multiple feasibility studies and com- parisons with the corresponding ‘‘open’’ procedure. In fact, all doubts have now been eliminated over the applicability of the laparoscopy on hypersecreting adrenal tumors, with particular reference to the pheocromocytoma, on large masses and secondary oncological pathology. Some perplexities remain over the useoflaparoscopyonprimaryadrenalcarcinoma,butwhenthefeasibilitycriteria are respected, many authors seem to prefer laparoscopy. This text aims to describe the main techniques for adrenal gland surgery— ‘‘open’’surgeryandlaparoscopy.Thebeginningofthereportdealswiththebasic physiological anatomy, clinical diagnosis and preoperative medication—the pre- requisitesneededtoaidthedescriptionofthesurgeryrequiredforsuchacomplex pathology.Thenastructuredandcomprehensiveexaminationofthemaintypesof surgical treatment used for these tumors is conducted, starting with the video- assisted methods, both in Gagner’s classic position, on the side, and the more recent posterior techniques. Particular emphasis is given to each procedure, indi- cations and contraindications, as well as the most frequent complications, giving rise to the suggestion that the recommendations, which arise from a high level of evidence, should be followed closely while addressing adrenal surgery. v vi Preface Thesurgicalinstrumentsandtechnologiesnecessarytocarryoutalaparoscopy, on the adrenal gland, are mentioned. In fact, this type of surgery demands, not only, a high level of technical expertise, but also a wide range of sophisticated equipment, indispensable in performing such advanced procedures as those described. Finally, adrenal gland ‘‘open’’ surgery is dealt with, focusing on the more relevant indications and contraindications. The text is structured on the basis of the principles of ‘‘Best practice’’, in accordance with the guidelines in ‘‘Evidence based medicine’’, and is therefore equipped with concrete information which can be rapidly transferred into clinical practice and daily techniques. To conclude this extensive analysis, the more modern attempts at surgical treatment for the adrenal pathology are described. This deals with the latest developments in the industry, like robotic surgery, and the technical skills of experiencedoperators,asinthecaseofthepartial,bilateraladrenalectomyandof the multi-organ resections. Thehopeisthatthereadermaybenefitfromthistext,acquiringacompleteand balanced knowledge ofthis complex subject matter, and using it as aninstrument ofreference.TheAuthorsknowthat,inthefuture,therapidevolutionofideasand methods could modify some of the concepts expressed here. Nevertheless, they trustthatthereader’scriticalandattentiveeyewillstimulatetheefforttomaintain this book, and its contents, fresh and up-to-date with further revisions. Andrea Valeri Carlo Bergamini Rocco Bellantone Celestino Pio Lombardi Contents 1 Historical Background or De quibusdam Renum glandulis: The History of Adrenals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Donatella Lippi 2 Surgical Anatomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Celestino Pio Lombardi, Carmela De Crea, Francesco Pennestri and Marco Raffaelli 3 Pathology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Gabriella Nesi and Raffaella Santi 4 Diagnosis and Clinical Pictures. . . . . . . . . . . . . . . . . . . . . . . . . . 35 Gabriele Parenti and Massimo Mannelli 5 Imaging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Massimo Falchini and Vittoria Rufini 6 Perioperative Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Tommaso Borracci, Luca Vitali, Lorenzo Antonuzzo, Liliana Sollazzi, Valter Perilli, Francesco Di Costanzo and Angelo Raffaele De Gaudio 7 General Principles of Adrenal Surgery . . . . . . . . . . . . . . . . . . . . 87 Robin M. Cisco and Quan-Yang Duh 8 Instrumentation and High-Technology . . . . . . . . . . . . . . . . . . . . 93 Francesco Corcione, Valentina Brancato and Michele Giuseppe Iovino 9 Right Flank Trans-Abdominal Laparoscopic Adrenalectomy . . . . 103 Carlo Bergamini and Andrea Valeri vii viii Contents 10 Left Flank Trans-Abdominal Laparoscopic Adrenalectomy . . . . . 127 Celestino Pio Lombardi, Marco Raffaelli, Carmela De Crea, Francesco Pennestri and Rocco Bellantone 11 Posterior Retroperitoneoscopic Adrenalectomy . . . . . . . . . . . . . . 135 Rocco Bellantone, Marco Raffaelli, Carmela De Crea, Luigi Oragano and Celestino Pio Lombardi 12 Open Adrenalectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Giorgio De Toma, Andrea Polistena and Giuseppe Cavallaro 13 Other Techniques of Video-Assisted and Open Adrenalectomies. . 161 Rocco Bellantone, Francesco Corcione, Celestino Pio Lombardi, Marco Raffaelli, Carmela De Crea, Luigi Oragano, Chiara Bellantone, Anna Settembre, Diego Cuccurullo, Vincenzo Cimmino and Luigi Barra 14 Outcome of Adrenal Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 Andrea Valeri and Carlo Bergamini Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Contributors Lorenzo Antonuzzo Section of Medical Oncology 1, Department of Oncology, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy, e-mail: [email protected] Luigi Barra Department of Laparoscopic and Robotic Surgery, ‘‘Azienda Dei Colli’’-Monaldi Hospital, Naples, Italy, e-mail: [email protected] TommasoBorracciSectionofAnesthesiologyandIntensiveCare,Departmentof Medical andSurgicalCriticalCare,UniversityofFlorence,AziendaOspedaliero- Universitaria Careggi, Florence, Italy, e-mail: [email protected] ValentinaBrancatoDepartmentofLaparoscopicandRoboticSurgery,‘‘Azienda Dei Colli’’-Monaldi Hospital, Naples, Italy, e-mail: valentina.brancato@gmail. com Carlo Bergamini General, Emergency and Mini-invasive Surgery Division, Emergency Room, General and Emergency Medicine and Surgery Department, Florence, Italy, e-mail: [email protected] Rocco Bellantone General and Endocrine Surgery Unit, Surgical Sciences Department, Hospital A. Gemelli Catholic University of Sacred Heart, Rome, Italy; Dipartimento di Scienze Chirurgiche, U.O. Chirurgia Generale ed Endoc- rina,Policlinico‘‘A.Gemelli’’,UniversitàCattolicadelSacroCuore,Rome,Italy, e-mail: [email protected] Giuseppe Cavallaro Department of Surgery ‘‘Pietro Valdoni’’, ‘‘Umberto I’’ UniversityHospital,UniversityofRome‘‘LaSapienza’’,VialedelPoliclinico155, 00161, Rome, Italy, e-mail: [email protected] VincenzoCimminoDepartment ofLaparoscopic andRoboticSurgery,‘‘Azienda Dei Colli’’-Monaldi Hospital, Naples, Italy, e-mail: [email protected] Robin M. Cisco Department of Surgery, Mt Zion Medical Center, University ofCaliforniaSanFrancisco,SanFrancisco,CA,USA,e-mail:Robin.cisco@ucsfmedctr. org ix x Contributors FrancescoCorcioneDepartmentofLaparoscopicandRoboticSurgery,‘‘Azienda Dei Colli’’-Monaldi Hospital, Naples, Italy, e-mail: francesco.corcione@ospedale monaldi.it Carmela DeCrea General and Endocrine Surgery Unit, Surgical Sciences Department, Hospital A. Gemelli Catholic University of Sacred Heart, Rome, Italy; Istituto di Semeiotica Chirurgica, Hospital ‘‘A. Gemelli’’, Catholic Uni- versity of Sacred Heart, Rome, Italy, Dipartimento di Scienze Chirurgiche, U.O. Chirurgia Generale ed Endocrina, Policlinico ‘‘A. Gemelli’’, Università Cattolica del Sacro Cuore, Rome, Italy, e-mail: [email protected] Diego Cuccurullo Department of Laparoscopic and Robotic Surgery ‘‘Azienda Dei Colli’’-Monaldi Hospital, Naples, Italy FrancescoDiCostanzoSectionofMedicalOncology1,DepartmentofOncology, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy, e-mail: [email protected] Quan-Yang Duh Department of Surgery, Mt Zion Medical Center, University ofCaliforniaSanFrancisco,SanFrancisco,CA,USA, e-mail:Quan-yang.duh@ucsfm edctr.org Massimo Falchini Department of Clinical Physiopathology University of Flor- ence Institute of Diagnostic Radiology, Florence, Italy, e-mail: massimo.falchini @unifi.it Angelo Raffaele DeGaudio Section of Anesthesiology and Intensive Care, Department of Medical and Surgical Critical Care, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy, e-mail: araffaele. degaudio@unifi.it Michele Giuseppe Iovino Department of Laparoscopic and Robotic Surgery, ‘‘Azienda Dei Colli’’-Monaldi Hospital, Naples, Italy, e-mail: iovinomg@gmail. com Donatella Lippi History of Medicine, Department of Anatomy, Histology and Legal Medicine, Faculty of Medicine and Surgery, University of Florence, Flor- ence, Italy, e-mail: donatella.lippi@unifi.it Celestino Pio Lombardi General and Endocrine Surgery Unit, Surgical Sciences Department, Hospital A. Gemelli Catholic University of Sacred Heart, Rome, Italy, e-mail: [email protected] MassimoMannelliEndocrinologyUnit,DepartmentofClinicalPathophysiology, University of Florence, Florence, Italy, e-mail: [email protected]fi.it Contributors xi Gabriella Nesi Division of Pathological Anatomy, University of Florence, Flor- ence, Italy, e-mail: gabriella.nesi@unifi.it Luigi Oragano General and Endocrine Surgery Unit Surgical Sciences Depart- ment, Hospital A. Gemelli Catholic University of Sacred Heart, Rome, Italy; Dipartimento di Scienze Chirurgiche, U.O. Chirurgia Generale ed Endocri- na, Policlinico ‘‘A. Gemelli’’, Università Cattolica del Sacro Cuore, Rome, Italy, e-mail: [email protected] Gabriele Parenti Biomedicine Endocrinology Unit, Azienda Ospedaliero-Uni- versitaria Careggi, Florence, Italy, e-mail: [email protected] Francesco Pennestri General and Endocrine Surgery Unit Surgical Sciences Department, Hospital A. Gemelli Catholic University of Sacred Heart, Rome, Italy, e-mail: [email protected] ValterPerilliDepartmentofAnesthesiaandIntensiveCare,PoliclinicoAgostino Gemelli, Università Cattolica Del Sacro Cuore, Rome, Italy Andrea Polistena Department of Surgery ‘‘Pietro Valdoni’’, ‘‘Umberto I’’ Uni- versity Hospital, University of Rome ‘‘La Sapienza’’, Viale del Policlinico 155, 00161, Rome, Italy, e-mail: [email protected] Marco Raffaelli General and Endocrine Surgery Unit Surgical Sciences Depart- ment, Hospital A. Gemelli Catholic University of Sacred Heart, Rome, Italy; Dipartimento di Scienze Chirurgiche, U.O. Chirurgia Generale ed Endocri- na, Policlinico ‘‘A. Gemelli’’, Università Cattolica del Sacro Cuore, Rome, Italy; Istituto di Semeiotica Chirurgica, U.O. Chirurgia Generale ed Endocrina, Poli- clinico ‘‘A. Gemelli’’, Università Cattolica del Sacro Cuore, Rome, Italy, e-mail: [email protected] VittoriaRufiniDepartmentofBioimagingandRadiologicalSciencesA.Gemelli Hospital, Institute of Nuclear Medicine, Catholic University of Sacred Heart, Rome, Italy, e-mail: v.rufi[email protected] Raffaella Santi Division of Pathological Anatomy University of Florence, Flor- ence, Italy, e-mail: raffaella.santi@unifi.it Liliana Sollazzi Department of Anesthesia and Intensive Care Policlinico Agostino Gemelli, Università Cattolica Del Sacro Cuore, Rome, Italy AnnaSettembreDepartmentofLaparoscopicandRoboticSurgery,‘‘AziendaDei Colli’’-Monaldi Hospital, Naples, Italy Giorgio DeToma Department of Surgery ‘‘Pietro Valdoni’’, ‘‘Umberto I’’ Uni- versity Hospital, University of Rome ‘‘La Sapienza’’, Viale del Policlinico 155, 00161, Rome, Italy, e-mail: [email protected]
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