Chen Yan,Zhou Lijun,Wang Yaping,et al.Robot-assisted laparoscopic adrenalectomy for children with adrenal pheochromocytoma: one case report with a literature review[J].Journal of Clinical Pediatric Surgery,,20():731-736.[doi:10.12260/lcxewkzz.2021.08.006]
Robot-assisted laparoscopic adrenalectomy for children with adrenal pheochromocytoma: one case report with a literature review
- Keywords:
- Robotic Surgical Procedures; Laparoscopy; Adrenal Gland Neoplasms; Pheochromocytoma; Child
- CLC:
- R736.6;R726.1
- Abstract:
- Objective To explore the efficacy and safety of robot-assisted laparoscopic partial adrenalectomy for pheochromocytoma in children. Methods One 8-year-old boy of adrenal pheochromocytoma was admitted in July 2020. Clinical data and surgical findings were retrospectively analyzed with a literature review. Results Hypertension was associated with other clinical symptoms. Imaging examination revealed an elliptic mass in right adrenal area. With a distinct boundary, there was no overt tumor invasion in the surrounding organs. And 24 h urinary vanillylmandelic acid (VMA), blood and 24 h urinary catecholamine metabolites spiked markedly. It hinted at pheochromocytoma. Robot-assisted laparoscopic partial adrenalectomy was performed after hypotension and volume expansion for 2 weeks. Tumor size was around 4×3×3 cm. Normal adrenal structure could be visualized and part of it was preserved during operation. The intra-abdominal procedure lasted 105 min and bleeding was around 400 mL. Blood transfusion was provided. Pathological examination confirmed pheochromocytoma with an intact capsule. The child recovered well after surgery and was hospitalized for 6 days. Reexamination of urinary VMA, blood and catecholamine metabolites in urine for 24 h remained basically normal. During a follow-up period of 6 months, both ultrasound and blood pressure normalized without other postoperative complications. Conclusion For adrenal pheochromocytoma in children, traditional laparoscopy is problematic. However, robotic-assisted laparoscopic partial adrenalectomy may be safely and selectively performed with minimal bleeding and shorter postoperative hospital stay.
References:
1 陈艳, 杨刚刚, 黄轶晨, 等. 机器人辅助腹腔镜下儿童肾上腺肿瘤切除术的初步探讨[J]. 中华小儿外科杂志, 2019, 40(2):137-142. DOI:10.3760/cma.j.issn.0253-3006.2019.02.009. Chen Y, Yang GG, Huang YC, et al. Preliminary experience of robot-assisted laparoscopic adrenalectomy for children with adrenal tumor[J]. Chin J Pediatr Surg, 2019, 40(2):137-142. DOI:10.3760/cma.j.issn.0253-3006.2019.02.009.
2 沈周俊, 夏磊磊, 何威, 等. 机器人辅助腹腔镜下肾上腺复杂肿瘤手术(附光盘)[J]. 现代泌尿外科杂志, 2014, 19(2):71-74. DOI:10.3969/j.issn.1609-8291.2014.02.001. Shen ZJ, Xia LL, He W, et al. Da Vinci robot-assisted laparoscopic adrenalectomy for complex adrenal tumor (compact disc included)[J]. J Mod Urol, 2014, 19(2):71-74. DOI:10.3969/j.issn.1609-8291.2014.02.001.
3 沈周俊, 夏磊磊.嗜铬细胞瘤手术方法的选择[J]. 现代泌尿外科杂志, 2014, 19(7):426-429. DOI:10.3969/j.issn.1009-8291.2014-07-003. Shen ZJ, Xia LL.Selections of surgical procedures for pheochromocytoma[J]. J Mod Urol, 2014, 19(7):426-429. DOI:10.3969/j.issn.1009-8291.2014-07-003.
4 Calì B, Nomine-Criqui C, Bihain F, et al. Robotic approach for partial adrenalectomy[J]. Updates in Surgery, 2021, 73(3):1147-1154. DOI:10.1007/s13304-020-00957-6.
5 Meehan JJ, Sandler A.Pediatric robotic surgery:A single-institutional review of the first 100 consecutive cases[J]. Surgical Endoscopy, 2008, 22(1):177-182. DOI:10.1007/s00464-007-9418-2.
6 Rogers CG, Blatt AM, Miles GE, et al. Concurrent robotic partial adrenalectomy and extra-adrenal pheochromocytoma resection in a pediatric patient with von Hippel-Lindau disease[J]. Journal of Endourology, 2008, 22(7):1501-1504. DOI:10.1089/end.2007.0314.
7 Julien JS, Ball D, Schulick R.Robot-assisted cortical-sparing adrenalectomy in a patient with Von Hippel-Lindau disease and bilateral pheochromocytomas separated by 9 years[J]. J Laparoendosc Adv Surg Tech A, 2006, 16(5):473-477. DOI:10.1089/lap.2006.16.473.
8 Volkin D, Yerram N, AhmedF, et al. Partial adrenalectomy minimizes the need for long-term hormone replacement in pediatric patients with pheochromocytoma and von Hippel-Lindau syndrome[J]. Journal of Pediatric Surgery, 2012, 47(11):2077-2082. DOI:10.1016/j.jpedsurg.2012.07.003.
9 Meignan P, Ballouhey Q, Lejeune J, et al. Robotic-assisted laparoscopic surgery for pediatric tumors:a bicenter experience[J]. Journal of Robotic Surgery, 2018, 12(3):501-508. DOI:10.1007/s11701-017-0773-2.
10 Mitra AP, Vasquez E, Kokorowski P, et al. Robotic adrenalectomy in the pediatric population:initial experience case series from a tertiary center[J]. BMC Urology, 2020, 20(1):155. DOI:10.1186/s12894-020-00727-x.
11 Ciftci AO, Tanyel FC, Senocak ME, et al. Pheochromocytoma in children[J]. J Pediatr Surg, 2001, 36(3):447-452. DOI:10.1053/jpsu.2001.21612.
12 Ross JH.Pheochromocytoma:special considerations in children[J]. Urol Clin North Am, 2000, 27(3):393-402. DOI:10.1016/s0094-0143(05)70088-4.
13 Bholah R, Bunchman TE.Review of pediatric pheochromocytoma and paraganglioma[J]. Front Pediatr, 2017, 5:155. DOI:10.3389/fped.2017.00155.
14 白悦心, 赵艺蕾, 沈卫萍, 等. 197例嗜铬细胞瘤临床分析[J]. 国际内分泌代谢杂志, 2007, 27(3):209-210. DOI:CNKI:SUN:GNFM.0.2007-03-021. Bai YX, Zhao YL, Shen WP, et al. Clinical analysis of pheochromocytoma:a report of 197 cases[J]. Intern J Endocrinol Metab, 2007, 27(3):209-210. DOI:CNKI:SUN:GNFM.0.2007-03-021.
15 Giordano, William C.Preservation of adrenocortical function during surgery for bilateral pheochromocytoma[J]. Journal of Urology, 1982, 127(1):100-102. DOI:10.1016/S0022-5347(17)53627-7.
16 Walz MK, Peitgen K, Hoermann R, et al. Posterior retroperitoneoscopy as a new minimally invasive approach for adrenalectomy:results of 30 adrenalectomies in 27 patients[J]. World Journal of Surgery, 1996, 20(7):769-774. DOI:10.1007/s002689900117.
17 Morris LF, Perrier ND.Advances in robotic adrenalectomy[J]. Current Opinion in Oncology, 2012, 24(1):1-6. DOI:10.1097/CCO.0b013e32834da8e1.
18 朱照伟, 屈武功, 朱阿丽, 等. 达芬奇机器人手术治疗复杂肾上腺嗜铬细胞瘤的临床疗分析[J]. 中华内分泌外科杂志, 2020, 14(3):204-207. DOI:10.3760/cma.j.issn.115807-20190514-00100. Zhu ZW, Qu WG, Zhu AL, et al. Clinical study of robotic management of complex pheochromocytoma[J]. Chin J Endocr Surg, 2020, 14(3):204-207. DOI:10.3760/cma.j.issn.115807-20190514-00100.
Memo
收稿日期:2021-05-24。
通讯作者:谢华,Email:drxiehua@163.com