Purpose: It is and always has been traditional to ligate the adrenal vein early during excision of a pheochromocytoma. This is done to limit catecholamine surges during intraoperative manipulation of the gland, potentially causing hemodynamic lability. This dogma, which originated from open surgery, has now been applied to the laparoscopic approach. At times, patient anatomy or size of the lesion can make early vein dissection difficult or unsafe. The purpose of this investigation is to challenge the “vein first” technique by demonstrating the safety and efficacy of delayed ligation of the adrenal vein during laparoscopic adrenalectomy for pheochromocytoma.
Methods: A retropspective review of all laparoscopic adrenalectomies for pheochromocytoma by a single surgeon from 1997 to 2007 was performed. All patients had confirmed histologic evidence of pheochromocytoma. The procedures were all performed utilizing the same technique, which involves division of the adrenal vein late in the procedure, after the majority of the gland has been dissected free. Patient records were reviewed for evidence of intra-operative hemodynamic variations, blood loss, length of stay and postoperative morbidity.
Results: Please refer to Tables 1 and 2 below:
Conclusions: Delayed adrenal vein ligation during laparoscopic adrenalectomy for pheochromocytoma is safe and effective. Intraoperative hemodynamic parameters are comparable to those reported in the literature using the “vein first” technique. Dividing the vein late is an alternative approach to laparoscopic excision of adrenal pheochromocytoma and should be considered in appropriate situations.
Program Number: P406