The Study Of Technique In Retroperitoneal Adrenalectomy Based On The The Anatomic Variations Of Adrenal Veins And Morbid Anatomy Regarding Feeding Vessels In Large Pheochromocytoma

ObjectiveTo evaluate the feasibility and safety of the technique in retroperitoneal adrenalectomy based on the the anatomic variations of adrenal veins and morbid anatomy in large pheochromocytoma.MethodsA retrospective analysis of 79 patients in Second Affiliated Hospital of Guangzhou Medical University underwent retroperitoneal laparoscopic adrenalect-omy.On the left,the adrenal vein joined an accessory renal vein in 2 cases.The adrenal vein and the inferior phrenic vein opened separately into the same of the renal vein in 4 cases.In 2 cases the adrenal vein drains directly into inferior vena cava.In 2 cases the adrenal gland was drained by two veins.On the right,the ectopic convergency with the lower right hepatic vein in 3 cases.In 1 case the adrenal vein opened just at the confluence of the renal vein and the inferior vena cava.In 1 cases the adrenal gland was drained by two veins.And there are 9 cases of large pheochromocytoma,The diameter ranged 6~8cm.We employed a technique in the retr-operitoneal adrenalectomy based on the morbid anatomy in large pheochromocytoma.The perioperative perimeter including operating times,estimated blood loss,tumor size,gland weight,histopathology,open convention,severe perioperative complication,postoperative hospital stay were recorded.ResultsThe retroperitoneal laparoscopic adrenalectomies were successfully performed in all cases.Mean operative time was 72±24 min(23~150min)and mean estimated blood loss was 76±32ml(5~160ml)and the postoperative hospital stays ranged 5~7 days in 15 cases of adrenal vascular variability.Mean operative time was 93±28 min(98~180min)and mean estimated blood loss was 121±29ml(90~220ml)and the postoperative hospital stays ranged 6~9 days in 6 cases of large pheochromocytoma.Tumor size ranged 6~8cm.Severe postoperative complications were not observed.ConclusionsBasic vessels of tumor turn to hyperplasia,disorder,enlarge;The surface vessels of tumor are spider web looking.The feeding vessels of tumor are from the triangle area of tumor base.Modification of zhang's three planes technique made the expose of tumor base easy and fasciculate dissection of basic vessels in retroperitoneal adrenalectomy based on the morbid anatomy in large pheochromocytoma is feasible and safe and a complete understanding and recognition of the anatomic variations in the drainage of the adrenal vein is the key point for the safe performance of laparoscopic adrenal surgery...