Dados do Trabalho

Título

adrenal right pheocromocitoma, minimally invasive surgery

Introdução

Adrenal gland incidentalomas are masses greater than 1 cm in diameter discovered unexpectedly on imaging studies performed in a patient with no suspected disease at the gland level.
It has a prevalence of 5% to 6% of the population, a figure that varies according to the age of the patient: less than 1% before the age of 30; 3% at age 50 and more than 15% after age 70. 10% to 15% of cases are bilateral. Regarding etiology, most originate in the adrenal cortex, less frequently in the medulla, and rarely are lesions of mesenchymal origin or adrenal metastases.

Objetivo

58-year-old patient, with a 3.4x4cm mass in the right adrenal gland, with hypertension, tomography reports a lesion compatible with adrenal adenoma, with defined borders, positive serum metanephrines. Minimally invasive adrenalectomy was decided

Método

A minimally invasive rigth suprarenalectomy was performed, with 4 ports, operating time 120 minutes, no intraoperative complications, discharged on the 5th day pop for blood pressure control.
The pathology reported a pheochromocytoma.
The surgical technique is described step by step through a minimally invasive approach.

Resultados

Minimally invasive adrenalectomy is a procedure that allows safe resection of most lesions, while allowing a short postoperative stay and early discharge with low morbidity and mortality. Incidental findings should be characterized and studied.
Diagnostic imaging and laboratory tests are key to proper management
Pheochromocytoma in associated with hypertension 0.5%-2% with incidence 1-2 / 100000

Conclusão

Minimally invasive adrenalectomy is a procedure that allows safe resection of most lesions, while allowing a short postoperative stay and early discharge with low morbidity and mortality. Incidental findings should be characterized and studied.
10% of incidentalomas correspond to non-neoplastic lesions such as cysts, pseudocysts, hematomas and granulomatous infections or lesions suspected of malignancy.
Imaging plays a fundamental role and is the diagnostic key in most patients, to define the course of action to follow: observation versus surgical resection.
The indications for surgery are clearly established: secretory lesions (hypercortisolism, hyperaldosteronism, pheochromocytoma) regardless of size and tumors suspected of being malignant (>4 cm, local invasion, density greater than 20 HU).

Vídeo

https://youtu.be/5PgdYGYunUQ