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Variations on a Theme: Comment on “Variant Adrenal Venous Anatomy in 546 Laparoscopic Adrenalectomies”

Variations on a Theme: Comment on “Variant Adrenal Venous Anatomy in 546 Laparoscopic... The number of adrenalectomies performed in the last 2 decades has almost doubled, and many of these procedures are being performed laparoscopically because of the improved patient outcomes associated with this surgical technique.1 Thus, knowledge of adrenal venous anatomy and its variations is important to avoid one of the common complications of an adrenalectomy, bleeding. Furthermore, in patients with pheochromocytoma, early identification and division of the adrenal vein(s) are often emphasized to minimize intraoperative hemodynamic instability. In a retrospective study of 546 consecutive laparoscopic adrenalectomies performed over 18 years, Scholten et al2 report variant adrenal venous anatomy in 13% of cases. Adrenal vein variants were more common in patients with pheochromocytomas and large primary tumors and in bilateral adrenalectomy procedures. Patients with variant adrenal venous anatomy had higher estimated blood loss but had no difference in postoperative bleeding. This study applies to a patient population undergoing adrenalectomies with an approach commonly used by most surgeons, and the data are based on observations of an experienced surgeon who paid attention to the details of the venous anatomy. It is not surprising that larger tumors and pheochromocytomas had higher rates of adrenal vein variants as parasitic vessels are common in these tumors. It would be interesting to know whether there was a significant difference in hemodynamic instability in patients with pheochromocytoma with and without variant adrenal veins. Because most adrenalectomies are performed in centers or by surgeons performing fewer than 4 to 6 per year and because complication rates may be associated with surgeon volume, determining the clinical factors (tumor size, pheochromocytoma) associated with a higher risk of bleeding provides useful information for anticipating this risk and for selecting the optimal surgical approach based on individual experience with laparoscopic adrenalectomies.1,3 Future prospective studies focused on developing comprehensive criteria will help to minimize bleeding during or after an adrenalectomy and to select the optimal surgical approach. Back to top Article Information Correspondence: Dr Kebebew, Endocrine Oncology Branch, National Cancer Institute, Bldg 10 CRC, Room 3-3940, 10 Center Dr, MSC 1201, Bethesda, MD 20892 (kebebewe@mail.nih.gov). Author Contributions:Study concept and design: Sadowski and Kebebew. Acquisition of data: Kebebew. Analysis and interpretation of data: Kebebew. Drafting of the manuscript: Sadowski and Kebebew. Critical revision of the manuscript for important intellectual content: Kebebew. Administrative, technical, and material support: Kebebew. Study supervision: Sadowski and Kebebew. Conflict of Interest Disclosures: None reported. References 1. Murphy MM, Witkowski ER, Ng SC, et al. Trends in adrenalectomy: a recent national review. Surg Endosc. 2010;24(10):2518-252620336320PubMedGoogle ScholarCrossref 2. Scholten A, Cisco RM, Vriens MR, Shen WT, Duh Q-Y. Variant adrenal venous anatomy in 546 laparoscopic adrenalectomies. JAMA Surg. 2013;148(4):378-383Google Scholar 3. Park HS, Roman SA, Sosa JA. Outcomes from 3144 adrenalectomies in the United States: which matters more, surgeon volume or specialty? Arch Surg. 2009;144(11):1060-106719917944PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Surgery American Medical Association

Variations on a Theme: Comment on “Variant Adrenal Venous Anatomy in 546 Laparoscopic Adrenalectomies”

Sadowski, Samira M.; Kebebew, Electron
JAMA Surgery , Volume 148 (4) – Apr 1, 2013
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Variations on a Theme: Comment on “Variant Adrenal Venous Anatomy in 546 Laparoscopic Adrenalectomies”

Abstract

The number of adrenalectomies performed in the last 2 decades has almost doubled, and many of these procedures are being performed laparoscopically because of the improved patient outcomes associated with this surgical technique.1 Thus, knowledge of adrenal venous anatomy and its variations is important to avoid one of the common complications of an adrenalectomy, bleeding. Furthermore, in patients with pheochromocytoma, early identification and division of the adrenal vein(s) are often...
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References (3)

Publisher
American Medical Association
Copyright
Copyright © 2013 American Medical Association. All Rights Reserved.
ISSN
2168-6254
eISSN
2168-6262
DOI
10.1001/jamasurg.2013.629
Publisher site
See Article on Publisher Site

Abstract

The number of adrenalectomies performed in the last 2 decades has almost doubled, and many of these procedures are being performed laparoscopically because of the improved patient outcomes associated with this surgical technique.1 Thus, knowledge of adrenal venous anatomy and its variations is important to avoid one of the common complications of an adrenalectomy, bleeding. Furthermore, in patients with pheochromocytoma, early identification and division of the adrenal vein(s) are often emphasized to minimize intraoperative hemodynamic instability. In a retrospective study of 546 consecutive laparoscopic adrenalectomies performed over 18 years, Scholten et al2 report variant adrenal venous anatomy in 13% of cases. Adrenal vein variants were more common in patients with pheochromocytomas and large primary tumors and in bilateral adrenalectomy procedures. Patients with variant adrenal venous anatomy had higher estimated blood loss but had no difference in postoperative bleeding. This study applies to a patient population undergoing adrenalectomies with an approach commonly used by most surgeons, and the data are based on observations of an experienced surgeon who paid attention to the details of the venous anatomy. It is not surprising that larger tumors and pheochromocytomas had higher rates of adrenal vein variants as parasitic vessels are common in these tumors. It would be interesting to know whether there was a significant difference in hemodynamic instability in patients with pheochromocytoma with and without variant adrenal veins. Because most adrenalectomies are performed in centers or by surgeons performing fewer than 4 to 6 per year and because complication rates may be associated with surgeon volume, determining the clinical factors (tumor size, pheochromocytoma) associated with a higher risk of bleeding provides useful information for anticipating this risk and for selecting the optimal surgical approach based on individual experience with laparoscopic adrenalectomies.1,3 Future prospective studies focused on developing comprehensive criteria will help to minimize bleeding during or after an adrenalectomy and to select the optimal surgical approach. Back to top Article Information Correspondence: Dr Kebebew, Endocrine Oncology Branch, National Cancer Institute, Bldg 10 CRC, Room 3-3940, 10 Center Dr, MSC 1201, Bethesda, MD 20892 (kebebewe@mail.nih.gov). Author Contributions:Study concept and design: Sadowski and Kebebew. Acquisition of data: Kebebew. Analysis and interpretation of data: Kebebew. Drafting of the manuscript: Sadowski and Kebebew. Critical revision of the manuscript for important intellectual content: Kebebew. Administrative, technical, and material support: Kebebew. Study supervision: Sadowski and Kebebew. Conflict of Interest Disclosures: None reported. References 1. Murphy MM, Witkowski ER, Ng SC, et al. Trends in adrenalectomy: a recent national review. Surg Endosc. 2010;24(10):2518-252620336320PubMedGoogle ScholarCrossref 2. Scholten A, Cisco RM, Vriens MR, Shen WT, Duh Q-Y. Variant adrenal venous anatomy in 546 laparoscopic adrenalectomies. JAMA Surg. 2013;148(4):378-383Google Scholar 3. Park HS, Roman SA, Sosa JA. Outcomes from 3144 adrenalectomies in the United States: which matters more, surgeon volume or specialty? Arch Surg. 2009;144(11):1060-106719917944PubMedGoogle ScholarCrossref

Journal

JAMA Surgery – American Medical Association

Published: Apr 1, 2013

Keywords: adrenal glands,adrenalectomy,laparoscopy

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