章 建全¹, 棚橋 善克¹, 千葉 裕², 豊田 精一¹, 喜屋武 淳¹, 中角 尚誉², 折笠 精一²

Jianquan ZHANG¹, Yoshikatsu TANAHASHI¹, Yutaka CHIBA², Seiichi TOYOTA¹, Atsushi KYAN¹, Hisayoshi NAKAZUMI², Seiichi ORIKASA²

¹東北公済病院泌尿器科, ²東北大学医学部泌尿器科

¹Department of Urology, Tohoku Kohsai Hospital, 2-3 Kokubun-cho, Aoba-ku, Sendai 981-0803, Japan, ²Department of Urology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan

キーワード : Adrenal adenoma, Endoscopic ultrasonography, Intraoperative ultrasonography, Laparoscopic adrenalectomy

Laparoscopic adrenalectomy is superior to open surgery in that it is minimally invasive, requiring only a small skin incision, and it eliminates the need to remove any ribs. Furthermore, early recovery and the lower financial cost resulting from the shorter period of hospitalization minimally affect the quality of life. The attending urologist, however, now confronts a new problem: loss of tactile sense during the laparoscopic procedure. Intraoperative endoscopic ultrasonography (EUS), a much more effective and convenient method for surgical guidance, adequately compensates for this loss, because of the good visualization provided by its real-time images. We performed retroperitoneal endoscopic ultrasonographic examinations on five patients with aldosteronomas or Cushing's adenomas during their laparoscopic adrenalectomies over a period of 4 months. Our preliminary experience demonstrated that intraoperative EUS has at least the following advantages over other imaging procedures. (1) It rapidly located adrenal glands and adenomas; (2) it accurately disclosed the involvement of a small lesion measuring approximately 5 mm across, one that CT, MRI, and TAUS had failed to identify preoperatively, and thus ensured the correct intraoperative approach of total adrenalectomy; (3) it clearly delineated the surrounding structures and their spatial relationship to the adrenal tumor; and (4) it reliably detected residual tumors present within the adrenal remnant immediately after a partial adrenalectomy. We thus recommended intraoperative EUS, when it is available, should be performed whenever a laparoscopic adrenalectomy, especially a partial one, is performed and whenever preoperative diagnostic uncertainty exists.