gms | German Medical Science

Background: Adrenal tumors not so often pathology in children, but arising from the adrenal cortex and the medulla present with a distinct characteristic and often manifest with wide spectrum of clinical features. Adrenal glands are ideally suitable for mini-invasive surgery, however the approach to the gland – transperitoneal or retroperitoneal – still under debate. The purpose of this work was to analyze our experience of applying these approaches to adrenal tumors in dependence of it side and size.

Materials and methods: Nineteen patients were operated laparoscopicaly: in 11 of them the retroperitoneal and in 8 – the transperitoneal approach was applied. There were 11 left-side and 8 right-side tumors. The mean tumor size was 37.7±4.2 mm (range, 10-94 mm).

Results: The tumor’s size and it functional activity didn’t influenced on the decision of the type of approach – the large (more than 50 mm) functional and non-functional tumors successfully removed by retroperitoneal and transperitoneal approach. The transperitoneal approach to the left-side tumors demands the mobilization of the descending colon and dangerous the injury of colon and pancreatic tail, due to that the retroperitoneal approach was applied in children with left-side tumors. The right-side adrenal tumors clear adjacent to v. cava inferior and in most of patients the small adrenal vessels peel off from it that required the carefully dissection and clipping. The limited working space of the retroperitoneal approach in the case of right-side tumors not ensures safety of adrenal dissection. Therefore, in all patients with right-side tumors the transperitoneal approach was applied.

Conclusion: Thus, the choice of the approach to the adrenal gland depends only of the localization of the tumor.