PRACTICAL ASPECTS OF LAPAROSCOPIC ADRENALECTOMY IN CHILDREN WITH BENIGN ADRENAL TUMORS



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Introduction. Despite of almost 30-year world experience in mini-invasive adrenalectomy in non-oncologic pediatric patients, this issue remains not fully understood and systematized in the domestic literature. Material and methods. Our work is based on 67 laparoscopic adrenalectomies performed in 65 patients, aged from 3 months to 17 years, with predominantly benign neoplasms. Despite of a thorough preoperative examination of each patient, we met malignant neoplasms in 7 cases: 4 - adrenocortical cancer and 3 - neuroblastomas (further they were treated by oncologists). Location of the neoplasms was as follows: right-sided - 31, left-sided - 26, bilateral - 8 (6 patients out of them had bilateral simultaneous removal). Average size of the removed formations was 4.65 ± 1.29 cm (maximum 12 cm). Results and discussion. The vast majority of detected adrenal neoplasms are removed. Exceptions may be neoplasms less than 4 cm in diameter with the native density less than 10 HU by computed tomography; however, they should be actively monitored by specialists. If a malignant process is suspected, patients should be examined more thoroughly and should be treated in specialized hospitals. Nowadays, a minimally invasive and safe surgical treatment of neoplasms in the adrenal glands depends on the experience and trainings of surgeons and anesthesiologists, as well as on the equipment in the operating room. A key to the successful treatment of patients with benign adrenal neoplasms is a specific attention to curative peculiarities in such patients as well as an adequate sequence of actions during laparoscopic adrenalectomy in its main stage, namely, ligation of the central adrenal vein.

作者简介

I. Poddubny

A.I. Yevdokimov Moscow State University of Medicine and Dentistry; Morozovskaya Children City Hospital, Healthcare Department of Moscow

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R. Oganesyan

Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology

Email: raisaoganesyan@gmail.com
ORCID iD: 0000-0002-1698-2956
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K. Tolstov

A.I. Yevdokimov Moscow State University of Medicine and Dentistry; Central Pediatric Clinical Hospital of the Federal Medico-Biological Agency of Russian Federation

Email: noemail@neicon.ru
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M. Kareva

Endocrinology Research Centre

Email: noemail@neicon.ru
ORCID iD: 0000-0003-1320-6561
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