Application of A Novel Intraoperative Hemodynamic Stabilization Technique During One-Stage Bilateral Partial Adrenalectomy for Multiple Bilateral Pheochromocytomas: A Clinical Case Report

Pheochromocytoma is a rare hormonally active tumor of the adrenal medulla characterized by catecholamine hypersecretion and a high risk of cardiovascular instability. Bilateral multiple forms of the disease represent a particular surgical challenge, requiring operative treatment with simultaneous preservation of cortical tissue to prevent chronic adrenal insufficiency. A critical stage of the procedure is venous outflow control, which is associated with the risk of pronounced arterial hypotension due to the abrupt cessation of catecholamine release into the systemic circulation. Objective. To present a clinical case of one-stage bilateral laparoscopic organ-sparing adrenalectomy for multiple bilateral pheochromocytomas using a developed intraoperative hemodynamic stabilization technique. Materials and Methods. A case of a female patient born in 1983 with clinical and laboratory signs of hormonally active tumors of both adrenal glands is described. Multislice computed tomography revealed bilateral lesions up to 4.7 cm in size. One-stage laparoscopic partial adrenalectomy was performed with maximal preservation of intact cortical tissue. At the stage of controlled venous outflow, rapid reinfusion of previously collected autologous blood (250 mL) synchronized with venous control was applied. Results. No critical intraoperative fluctuations in arterial blood pressure were recorded, and vasopressor support was not required. The postoperative period was uneventful. Plasma metanephrine and normetanephrine levels normalized. Histological examination confirmed the diagnosis of pheochromocytoma (ICD-O 8700/3). Conclusion. One-stage bilateral laparoscopic organ-sparing adrenalectomy is a feasible and safe treatment option in specialized centers. The use of synchronized autologous reinfusion may be considered a pathogenetically justified method for the prevention of post-clamping hypotension during surgical treatment of hormonally active adrenal tumors.

Hali tarjima qilinmagan