單手輔助式腹腔鏡切除大型腎上腺髓質脂肪瘤
李淑文1、薛又仁1,2、黃建榮1、蕭毅君1、賴昱維1、邱文祥1
1臺北市立聯合醫院仁愛院區 外科部 泌尿科；2 國立陽明大學 醫學院 泌尿學科
Hand-assisted laparoscopic adrenalectomy for large adrenal myelolipoma
Shu-Wen Li1, Thomas Y. Hsueh1,2, Andy. C. Huang1, Yi-Chun Hsiao1, Yu-Wei Lai1,2,
Allen W. Chiu1,2
1Division of Urology, Department of Surgery, Taipei City Hospital renai Branch, Taipei, Taiwan;
2Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
Introduction: Adrenal myelolipoma is a rare, benign, and non-functioning tumor. Surgical resection is indicated in symptomatic patients, large size (> 4cm), progressive tumor enlargement and atypical appearance on radiographic studies. Herein we reported two cases with huge adrenal myelolipoma received hand-assisted laparoscopic adrenalectomy.
Presentation of case: Two cases with large adrenal myelolipoma were reported. A 52-year-old man presented to our urological clinic with right-sided flank pain and hematuria. An adrenal myelolipoma(5cm) was identified via abdominal computed tomography. Another 58-year-old woman had abdominal pain for 3 months, and a retroperitoneal hyperechoic lesion was shown on abdominal sonogram. A large right adrenal myelolipoma(8cm) was found via abdominal computed tomography. All endocrine studies showed negative results in both patients. They underwent hand-assisted transperitoneal laparoscopic adrenalectomy. The mean operative time was 120 minutes and the mean blood loss was 75cc. Both patients evolved with an uneventful postoperative period, and were discharged within 6 days postoperatively. The pathologic exam showed adrenal myelolipoma measuring 5.5cm and 7.2cm respectively.
Conclusion: The benefits of the laparoscopic approach consist of a shorter hospital stay, reduced morbidity, decreased analgesic requirement, and reduced intraoperative blood loss. Hand-assisted laparoscopic surgery provides the tactile feedback and counteract traction, thus facilitating the operative manipulations. Our report suggests that hand-assisted laparoscopic adrenalectomy is a safe, feasible, and effective approach for the treatment of large adrenal myelolipomas.