Laparoscopic Radiofrequency Ablation of Adrenal Tumors

Background: Despite reports of percutaneous radiofrequency ablation (RFA), laparoscopic ablative techniques have not been described to treat adrenal tumors. The aim of this study is to describe patient selection criteria and the technique for laparoscopic adrenal RFA.

Methods: Four patients underwent laparoscopic RFA of adrenal tumors under general anesthesia for adrenal tumors. Procedures were performed under the guidance of laparoscopic ultrasound. Ablations were performed using Angiodynamics Model 30 (n=1) 3cm and Model 90 (n=3) 5cm ablation catheters. Medical records of these patients were reviewed retrospectively.

Results: Pathology included lung metastasis in 2 patients, and renal cell cancer metastasis and cortical adenoma in 1 patient each. Metastatic lesions were not resectable due to concomitant liver metastasis in 2 patients and due to local invasion in the third patient. The first 2 patients also underwent concomitant laparoscopic liver RFA. In the fourth patient with adrenocortical adenoma, ablation was performed due to the cardiopulmonary instability of the patient during attempted laparoscopic adrenalectomy. Two patients had right and 2 patients had left sided lesions. Despite normal catecholamine levels preoperatively, 2 patients had a transient hypertensive period during the ablation, possibly due to release of catecholamines from the normal adrenal medulla. The procedures were performed using a supine (n=2), lateral transabdominal (n=1) or posterior (n=1) approach. There were no perioperative complications or mortality. The ablated lesions demonstrated a non enhancing hypodense appearance in postoperative CT scans. Patients were followed up for a mean 19 months. One patient died at three months from cardiac causes and 1 other patient died at 51 months.

Conclusions: To our knowledge, this is the first report of laparoscopic adrenal RFA. Laparoscopic RFA is an option for patients with unresectable adrenal tumors due to extent of disease or comorbidities. The procedure can be performed safely using any standard laparoscopic adrenalectomy approaches.

Session: Podium Presentation

Program Number: S088

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