Laparoscopic Right Adrenalectomy After Superior Heminephrectomy in a Child

Abstract

Introduction:

Laparoscopic adrenalectomy (LA) is widely described in adult population since its first report by Gagner et al. in 1992. ¹ In contrast, its applicability in pediatric malignancy remains unsettled. According to current evidence, LA in children is acceptable for resection of pheochromocytomas, ² benign tumors, and adrenal hyperplasia. ³ The authors present a video of a challenging laparoscopic right adrenalectomy in a child after homolateral superior polar heminephrectomy.

Materials and Methods:

This is a case of an 11-year-old girl with LiFraumeni syndrome. She had a past medical history of a central nervous system glioma treated when she was 4 years old. Six years later, a nodule on the upper pole of the right kidney with malignant features on imaging was diagnosed, and she underwent right superior heminephrectomy through a subcostal retroperitoneal approach. The specimen revealed that it was an eosinophilic renal carcinoma. One year later, during follow-up, a new nodule on the right adrenal gland was found. Because of the patient's history and malignant risk, she was proposed to tumor excision using a minimally invasive approach. During laparoscopy, important adhesions between the abdominal wall, the kidney, and the right lobe of the liver were found. After careful liberation and dissection, the adrenal tumor was found and excised. The postoperative course was uneventful and was discharged on the second postoperative day. After 1 year, the girl is doing well and is still under surveillance for further tumor development.

Conclusion:

A laparoscopic approach transforms a major surgery that requires a significant abdominal incision to operate in a difficult access area into a relatively simple and safe procedure. Particularly in patients in whom further surgeries are expected during their lifetime, a minimally invasive approach grants less future iatrogenic complications because of diminished risk for adhesion formation.

No competing financial interests exist.

Runtime of video: 7 mins 29 secs