Laparoskopska adrenalektomija

master's thesis

• Title (english): Laparoscopic adrenalectomy
• Author: Toni Zekulić
• Mentor: Nikola Knežević (mentor)
• Committee member: Tvrtko Hudolin (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Nikola Knežević (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Urology); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Urology

Abstract

Tumori nadbubrežne žlijezde uglavnom su benigni i danas se najčešće slučajno otkrivaju tijekom radiološke obrade zbog drugih simptoma te se nazivaju incidentalomi. Većina tumora nadbubrežne žlijezde je hormonski neaktivna. Aktivni tumori nadbubrežne žlijezde produciraju hormone i dovode do razvoja karakteristične kliničke slike. Operativno liječenje u pravilu predstavlja prvi izbor u liječenju klinički značajnih tumora nadbubrežne žlijezde. U proteklih dvadeset godina, laparoskopska adrenalektomija se, nametnula kao zlatni standard za operativno liječenje većine benignih lezija nadbubrežne žlijezde. Zbog minimalne invazivnosti postupka, u usporedbi sa otvorenom adrenalektomijom, povezana je sa manje komplikacija, manjom postoperativnom boli, bržim oporavkom i kraćim vremenom hospitalizacije. Trenutne indikacije za laparoskopsku adrenalektomiju uključuju funkcionalne tumore nadbubrežne žlijezde, nefunkcionalne tumore veće od 4 centimetra i one čije radiološke osobine upućuju na malignost ili im se veličina značajno poveća u kraćem vremenskom intervalu. Indikacije uključuju i simptomatske adrenalne ciste i bilateralnu adrenalnu hiperplaziju. Laparoskopski pristup ima prednost nad otvorenim, osim u slučajevima kada se radi o adrenokortikalnom karcinomu i tumorima većim od 8 centimetara. Unatoč tome, stalnim razvojem tehnike se i takvi tumori operiraju laparoskopski, ali uz veći rizik komplikacija i konverzije na otvoreni pristup. Postoje dva kirurška pristupa za laparoskopsku adrenalektomiju; transperitonealni i retroperitonealni. Transperitonealnim pristupom se omogućuje stvaranje većeg operacijskog polja uz bolju preglednost, a retroperitonealnim se smanjuje rizik ozljede unutarnjih organa i postoperativnog ileusa. Obje kirurške tehnike su visoko učinkovite u rukama iskusnih kirurga i nema značajnijih razlika u konačnom ishodu operacije.

Abstract (english)

Tumors of the adrenal glands are mostly benign and they are most commonly detected during radiological treatment due to other symptoms and are called incidentalomas. Most adrenal tumors are hormone inactive. Active tumors of the adrenal glands produce certain hormones and lead to the development of a characteristic clinical picture. Operative treatment is usually the first choice in the treatment of clinically significant adrenal gland tumors. Over the past twenty years, minimal invasive laparoscopic adrenalectomy has been imposed as a gold standard for the treatment of most benign lesions of the adrenal gland. Compared with open adrenalectomy, beacuse of its minimaly invasive aproach, it is associated with fewer complications, less postoperative pain, faster recovery, and shorter hospitalization. Current indications for laparoscopic adrenalectomy include functional tumors of the adrenal gland, nonfunctional tumors larger than 4 centimeters and those whose radiological properties indicate malignancy or their size significantly increases in a short time interval. Indications also include symptomatic adrenal cysts, myelolipomas, and bilateral adrenal hyperplasia. Laparoscopic approaches have an advantage over the open, except in cases of adrenocortical carcinoma and tumors larger than 8 centimeters. Nonetheless, with ongoing development techniques, such tumors can be managed laparoscopically, but with greater risk of complications and conversions in open access. There are two surgical approaches to laparoscopic adrenalectomy; transperitoneal and retroperitoneal. With transperitoneal access, it is possible to create a larger field of operation with better visibility, and the retroperitoneal access reduces the risk of internal organ injuries and postoperative ileus. Both surgical techniques are highly effective in the hands of experienced surgeons and there are no significant differences in the ultimate outcomes of the operation.

• Keywords: nadbubrežna žlijezda; laparoskopska adrenalektomija; tumori nadbubrežne žlijezde; incidentalom; feokromocitom; otvorena adrenalektomija
• Keywords (english): adrenal gland; laparoscopic adrenalectomy; adrenal gland tumors; incidentalomas; pheochromocytoma; open adrenalectomy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:075347
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-01-04 08:02:16