Zusammenfassung
Bei ausreichender chirurgischer Erfahrung kann die endoskopische Adrenalektomie (EA)
mit geringem Blutverlust, niedriger Umstiegsrate und geringen Komplikationen eingesetzt
werden. Immerhin 6 neuere Untersuchungen mit jeweils mindestens 100 Eingriffen zeigen
einheitliche und durchweg positive Ergebnisse, was auch den eigenen Erfahrungen mit
der EA entspricht. Die Konversionsraten (3 - 5 %) ebenso wie die Morbiditätsraten
(8 - 18 %) sind niedrig, die Mortalität ist mit < 1 % sehr gering. Die EA ist den
herkömmlichen Verfahren hinsichtlich der bekannten Vorteile der minimalinvasiven Chirurgie
deutlich überlegen. Trotz fehlender kontrollierter Untersuchung gilt die EA mittlerweile
bei nicht malignen adrenalen Tumoren < 5 - 7 cm als Verfahren der Wahl. Die EA kann
transperitonel laparoskopisch (TEA) oder retroperitoneal (REA, von posterior oder
lateral) durchgeführt werden, eine vergleichende Bewertung fällt wie in der offenen
Chirurgie schwer. Obwohl mit der TEA die größeren Erfahrungen vorliegen, zeichnet
sich ein Punktvorteil für die REA ab. Hier spielen abdominelle Voroperationen keine
Rolle, intraabdominelle Organe müssen nicht mobilisiert oder zur Seite gehalten werden.
Andererseits ist die anatomische Orientierung schwieriger. Speziell für adipöse Patienten
scheint die REA besser geeignet. Die bisher selten praktizierte partielle Adrenalektomie
wird in endoskopischer Technik zunehmend beliebter, Benefit und Indikationen müssen
in weiteren Untersuchungen noch präzisiert werden.
Abstract
With increasing surgical experience, endoscopic adrenalectomy (EA) is performed with
minimal blood loss, low conversion rate to open surgery and minimal complications.
The outcome of 6 recently published studies each including > 100 patients was well
balanced and generally positive, well in accordance with our own experience with EA.
Conversion rate was 3 - 5 %, morbidity 8 - 18 % and mortality was very low (< 1 %).
Displaying all of the common advantages of minimally invasive surgery, EA is clearly
superior to conventional procedures. Despite a lack of controlled studies, EA has
become the procedure of choice for benign adrenal tumors < 5 - 7 cm. EA may be performed
by a transperitoneal laparoscopic (TEA) or by a retroperitoneal (REA, posterior or
lateral) approach; as in open surgery possible advantages of one or the other are
difficult to evaluate. There is a lot of experience with TEA, but REA seams to have
slight advantages. With REA prior abdominal surgery is negligible, there is no need
to dissect or retract intraperitoneal structures. In contrast anatomical orientation
may be more difficult. REA seems to be the better option in obese patients. With EA,
partial adrenalectomy is more frequently used, further studies are needed to evaluate
benefit and indications.
Schlüsselwörter
Laparoskopische Adrenalektomie - minimalinvasive Chirurgie - Übersicht
Key words
Laparoscopic adrenalectomy - minimally invasive surgery - review
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Th. Neufang
Chirurgische Klinik, Universitätsklinikum Mannheim, Fakultät für klinische Medizin
Mannheim der Universität Heidelberg, Mannheim
Theodor-Kutzer-Ufer 1 - 3
68127 Mannheim
Phone: 0621/3832225
Fax: 0621/3832166
Email: thomas.neufang@chir.ma.uni-heidelberg.de
