Laparoscopic Anterior Adrenalectomy and Paraganglioma Resection in an Adolescent

Abstract

Pheochromocytomas and paragangliomas are rare neuroendocrine tumors in the pediatric population; however, they represent the most common endocrine tumor in childhood. We present a 16-year-old male treated laparoscopically for concurrent left adrenal pheochromocytoma and a paraganglioma located at the Organ of Zuckerkandl. His medical history was significant for headaches, and idiopathic erythrocytosis managed with repeated phlebotomy and saline infusions. Due to vision changes in his right eye, an ophthalmologic examination was performed with evidence of papilledema. An episode of malignant hypertension developed requiring intensive care unit admission and systematic evaluation. Computed tomography of the abdomen and pelvis demonstrated a mass in the left adrenal gland and another mass inferior to the aortic bifurcation. Alpha-blockade and volume resuscitation were performed. Briefly, with the patient in the modified lithotomy position, a laparoscopic transperitoneal (anterior) resection of a bilobed left adrenal pheochromocytoma was performed by medial mobilization of the left colon with an endoscopic vessel sealing device, identification and division of the left adrenal vein with endoscopic stapler, and an additional endoloop, followed by division of the remaining adrenal attachments, and finally with removal of the mass located at the Organ of Zuckerkandl. Both masses were removed from the intraperitoneal space through endocatch bag. Histologic findings were consistent with pheochromocytoma at both sites. His recovery from laparoscopy as treatment for this exceedingly rare pathology was uncomplicated.

No competing financial interests exist.

Presentation:

Presented at the International Pediatric Endosurgery Group's 24th Annual Congress for Endosurgery in Children, Nashville, TN, April 18, 2015.

Runtime of video: 5 mins 5 secs