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ResumenA nivel mundial han surgido varias preocupaciones y controversias respecto a las adrenalectomías laparoscópicas realizadas en tumores malignos que ponen en cuestión la eficacia y efectividad del procedimiento; sin embargo, no es así en la adrenalectomía laparoscópica en las masas suprarrenales benignas que es considerada el «gold estándar» en el tratamiento.Se presenta el caso de un paciente femenino de 39 años de edad con antecedentes de hipertensión arterial sistémica de reciente diagnóstico de difícil control, referida desde endocrinología con el diagnóstico de tumoración suprarrenal derecha. Metanefrinas totales en orina de 24h: 5,844μg/24h (rango 36-203μg/24h); catecolaminas totales en orina de 24h: 289μg/24h. La TAC muestra masa ocupante en glándula suprarrenal derecha, de 8cm de diámetro, de aspecto tumoral, sólida, ovalada e hipodensa, sin calcificaciones, con leve reforzamiento al contraste y áreas de menor atenuación en su interior que sugieren necrosis.Se realiza adrenalectomía derecha laparoscópica. Tiempo quirúrgico: 195min. Sangrado transquirúrgico: 450ml; la pieza quirúrgica se extrajo por herida de 5cm en fosa iliaca derecha. Estancia hospitalaria 3 días. El estudio histopatológico reportó feocromocitoma. El resultado quirúrgico es equiparable a la cirugía abierta, sumándole los beneficios de la cirugía de mínima invasión.AbstractVarious concerns and controversies have emerged worldwide with respect to laparoscopic adrenalectomy performed on malignancies that have called into question the efficacy and effectiveness of the procedure. Nevertheless, laparoscopic adrenalectomy is considered the gold standard of treatment when performed on benign adrenal masses.A 39-year-old woman had a past history of recently diagnosed and difficult-to-control high blood pressure and was referred by the endocrinology service with the diagnosis of a right adrenal gland tumor. Total metanephrines in 24-h urine were 5,844μg/24h (range: 36-203μg/24h) and total catecholamines in 24-h urine were 289μg/24h. A computed axial tomography scan showed an 8cm occupying mass on the right adrenal gland with a tumoral aspect that was solid, oval-shaped, and hypodense; it had no calcifications, slight contrast enhancement, and less attenuated areas in its interior suggesting necrosis.A laparoscopic right adrenalectomy was performed. Surgery duration was 195min, intraoperative blood loss was 450ml, the surgical specimen was extracted through an approximately 7cm-long wound in the right iliac fossa, and hospital stay was 3 days. The histopathologic study reported pheochromocytoma. The surgical result was comparable to that of open surgery, with the added benefits of minimally invasive surgery. |
