Evelyn Dorado. FUNDACION VALLE DEL LILI
INTRODUCTION: Primary hyperaldosteronism or Conn disease has an incidence of 10% of the causes of hypertension. This is curable disease and 70% of these have an adenoma associated .The symptoms are hypertension, hipokalemia and fatigue. The treatment is remove the lesión by minimally invasive approach.
MAIN: Describe the technique and results of posterior retroperitoneal approach in patients with primary hiperaldosteronism.
MATERIAL AND METHODS: retrospective descriptive. 7 patients ( 3 females/4 males) 45 y/o, between April 2015 and September 2016 with diagnosis by CT SCAN or RMN of adrenal mass + biochemical findings in blood test and selective catheterization of adrenal vein of high aldosterone levels, hypokalemia plus characteristic symptoms such as cramps, fatigue and hypertension. One patient has a left incidentaloma with a history of colectomy for colon cancer, open eventrorraphy with mesh. All patients were managed with endocrinology.
RESULTS: All patients under general anesthesia in prone position with knees bent Figure 1 . We drawn a line to identify the limits of dissection: the rim of the 11 and 12 rib and spine, with a 3 ports technique: # 2 of 5 mm and 1 of 12 mm. we started introduce on midline below of 12 rib 12 mm incision, open the fascia until retroperitoneal space and with dissecting balloon wecreate the retroperitoneal space, then with the finger we felt the tip of the two additional trocars and started with 30 mm Hg CO2 pressure . our landmarks were: the superior kidney pole and with bipolar disected all the fat tissue. We diseccted and clipped with 5 mm Hemolok the médium adrenal vein and finish the disecction with bipolar. We used a endobag to extract the gland and diminished the gas pressure to checked hemostasia.
all patients refered no pain after de surgery and the scale of pain was minimal, the OR time was 30 minutes and the patients started oral intake 4 hours after de surgery. Discharge next day with oral paracetamol and all the patology study demostrated adenoma figure 2
CONCLUSION: Minimally invasive surgery is the standard of many of the surgical procedures. For adrenal diseases, transabdominal approach is the most used. The posterior retroperitoneoscopic approach has proven to be faster, blood less, does not produce the effects of diaphragmatic irritation or cardiovascular side effects to using CO2 and the more important is painless.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77769
Program Number: P699
Presentation Session: Poster (Non CME)
Presentation Type: Poster