Online Journal
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Journal of Medical Ultrasonics

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1999 - Vol.26

Vol.26 No.11

Original Article(原著)

(1105 - 1109)


The Role of Intraoperative Retroperitoneal Endoscopic Ultrasonography in Laparoscopic Adrenalectomy

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.