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Toklu A, Mesa H, Collins K. Incidental adrenal hemangioma clinically suspicious for malignancy: diagnostic considerations and review of the literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2022; 15:444-458. [PMID: 36507066 PMCID: PMC9729942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/15/2022] [Indexed: 12/15/2022]
Abstract
Adrenal hemangiomas are rare lesions often found incidentally during unrelated diagnostic work-up. We report a case of a 67-year-old man with history of hypertension, hyperlipidemia, anemia, arthralgia, joint swelling and unexplained weight loss, which prompted imaging studies. Computed tomography scan revealed a 5.4 cm adrenal mass. The patient had no clinical manifestations of adrenal medullary or cortical hyperfunction. Urine and plasma metanephrines and aldosterone/renin ratio were within normal range. The patient was taking prednisone for hand and ankle swelling, precluding assessment for Cushing syndrome. Given the size of the lesion, the possibility of malignancy was considered, and the patient elected for surgical management. The left adrenalectomy specimen weighed 54 g and revealed a 4.9 cm tan-brown mass with congested cut surface and a thin rim of residual adrenal gland parenchyma. Histologic examination showed thick and thin-walled vessels intermingled with adrenocortical elements at the periphery characteristic of a hemangioma. Surgical resection is the mainstay treatment for large, isolated adrenal masses to exclude malignancy and prevent retroperitoneal hemorrhage. Herein, we report a case of adrenal hemangioma, review a variety of other diagnostic considerations occurring in the adrenal gland, and highlight useful distinguishing features to assist in accurate diagnosis.
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[Adrenal cavernous hemangioma: A case report and literature review]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53. [PMID: 34393250 PMCID: PMC8365077 DOI: 10.19723/j.issn.1671-167x.2021.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A 57-year-old male patient was referred to our department with complaints of his right adrenal gland occupancy and hypertension about 6 months. When admitted to the hospital, the blood pressure was about 160/100 mmHg, and the heart rate was 110 beats/min. He was no obvious obesity, acne, abnormal mood, without weakness of limbs, acral numbness, palpitation and headache. He presented with type 2 diabetes for more than 3 years, with oral administration of metformin enteric coated tablets and subcutaneous injection of insulin glargine to control blood glucose, and satisfied with blood glucose control. Enhanced CT showed that: the right adrenal gland showed a kind of oval isodense, slightly hypodense shadow, the edge was clear, lobular change, the size was about 5.8 cm×5.4 cm, uneven density, there were nodular and strip calcification, round lipid containing area and strip low density area, and the CT value of solid part was about 34 HU. Enhanced scan showed heterogeneous nodular enhancement in the solid part of the right adrenal gland, nodular enhancement could be seen inside. The CT values of solid part in arterial phase, venous phase and delayed phase were 45 HU, 50 HU and 81 HU, respectively. Considering from the right adrenal gland, cortical cancer was more likely. No obvious abnormality was found in his endocrine examination. After adequate preoperative preparation, retroperitoneal laparoscopic adrenalectomy was performed under general anesthesia. During the operation, the 6 cm adrenal tumor was closely related to the inferior vena cava and liver, and after careful separation, the tumor was completely removed and normal adrenal tissue was preserved. The operation lasted 180 min and the blood loss was 100 mL, and the blood pressure was stable during and after the operation. There was no obvious complication. The results of pathological examinations were as follows: the size of the tumor was 7.5 cm×6.0 cm×3.5 cm, soft, with intact capsule and grayish-red cystic in section. Pathological diagnosis: (right adrenal gland) cavernous hemangioma, secondary intravascular thrombosis, old hemorrhagic infarction with calcification and ossification. After 6 months of observation, no obvious complications and tumor recurrence were found. In summary, cavernous hemangioma of adrenal gland is a rare histopathological change. Its essence is a malformed vascular mass. Blood retention is the cause of thrombosis and calcification in malformed vessels. The imaging findings were inhomogeneous enhancement of soft tissue masses, and the adrenal function examination showed no obvious abnormalities. Retroperitoneal laparoscopic surgery is feasible after adequate preoperative preparation. It is difficult to diagnose the disease preoperatively and needs to be confirmed by postoperative pathology.
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Huang T, Yang Q, Hu Y, Wu HX. Adrenal cavernous hemangioma misdiagnosed as pheochromocytoma: a case report. BMC Surg 2021; 21:210. [PMID: 33902538 PMCID: PMC8074472 DOI: 10.1186/s12893-021-01195-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adrenal hemangioma is a rare benign adrenal tumor that is usually misdiagnosed preoperatively. We here present a case of adrenal cavernous hemangioma that was successfully treated with retroperitoneal laparoscopic adrenalectomy. CASE PRESENTATION A 67-year-old man with dull right back pain attended our clinic for examination of a mass on the right adrenal gland for 1 week. Pheochromocytoma was considered according to the preoperative computed tomography angiography + computed tomography urography findings and was subsequently corrected to adrenal gland hemangioma according to postoperative pathological findings. The patient showed no recurrence of adrenal hemangioma during the 1-year follow-up period after surgery. CONCLUSION Adrenal gland hemangioma is rare with a high rate of misdiagnosis, and it should be considered in imaging findings of adrenal tumors with typical hemangioma. Surgery is an effective treatment method.
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Affiliation(s)
- Ting Huang
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, China.
| | - Qing Yang
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, China
| | - Yang Hu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, China
| | - Hai-Xiao Wu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, China
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Adrenal hemangioma: A rare presentation of bleeding incidentaloma: Case report. Int J Surg Case Rep 2020; 77:442-445. [PMID: 33395822 PMCID: PMC7691671 DOI: 10.1016/j.ijscr.2020.11.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 11/29/2022] Open
Abstract
Adrenal incidentalomas are tumors found accidentally by imaging. Hemangiomas are quite rare and in certain cases their surgical intervention should never be overlooked. Embolization is primarily implied but one should never neglect the failure rate and the need for surgical intervention. There are 4 types of AH: cavernous hemangioma, venous hemangioma, capillary type hemangioma, and mixed hemangioma. To our knowledge, our case has the largest size of an AH being reported in the literature with a 17 cm.
Introduction Adrenal incidentalomas are tumors found accidentally by imaging. Among the incidentalomas, hemangiomas are quite rare and in certain cases their surgical intervention should never be overlooked. Presentation of case We present a case of 70 years old Lebanese female with an adrenal tumor presented as syncope found to have anemia on presentation and a bleeding 17 cm adrenal tumor on imaging. Patient had workup to rule out functioning adrenal tumors and decision to excise the tumor was taken after failure of embolization. Pathology report denied malignancy despite of the huge size and was in favor of hemangioma. Conclusion Adrenal hemangiomas are rare and they rarely present as syncope. Attention to such a life-threatening condition should be sustained. Embolization is primarily implied but one should never neglect the failure rate and the need for surgical intervention.
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Gupta A, Gupta A, Gupta S, Durgapal P, Sideek RAT, Verma S. Cavernous Hemangioma of the Adrenal Gland: A Rare Adrenal Incidentaloma. Niger J Surg 2020; 26:159-161. [PMID: 33223816 PMCID: PMC7659751 DOI: 10.4103/njs.njs_12_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/08/2019] [Accepted: 05/17/2019] [Indexed: 11/24/2022] Open
Abstract
Cavernous hemangiomas of the adrenal gland are rare, benign, endocrinologically inactive tumors. They present as adrenal incidentalomas, mostly asymptomatic, but patients may have abdominal pain. Surgery is the mainstay of treatment.
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Affiliation(s)
- Amit Gupta
- Department of Surgery, AIIMS, Rishikesh, Uttarakhand, India
| | - Ashish Gupta
- Department of Surgery, AIIMS, Rishikesh, Uttarakhand, India
| | - Sweety Gupta
- Department of Radiation Oncology, AIIMS, Rishikesh, Uttarakhand, India
| | | | | | - Shashank Verma
- Department of Surgery, AIIMS, Rishikesh, Uttarakhand, India
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Adrenal Cavernous Hemangioma: A Rarely Perceived Pathology-Case Illustration and Review of Literature. Case Rep Pathol 2019; 2019:8463890. [PMID: 31949968 PMCID: PMC6944974 DOI: 10.1155/2019/8463890] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/03/2019] [Accepted: 11/29/2019] [Indexed: 12/02/2022] Open
Abstract
Cavernous hemangiomas are endothelial tumors that rarely affect the adrenal glands. Most of these tumors remain silent and are incidentally found on abdominal imaging. Hardly ever, these tumors are endocrinologically functional. They may present as vague abdominal pain. Surgical resection remains the mainstay for large masses. In this paper, we are presenting a case of adrenal cavernous hemangioma in a 83-year-old male patient who initially presented for workup of vague abdominal and bilateral flank pain. A computed tomography scan of the abdomen showed an 8 cm right adrenal adenoma which was metabolically nonfunctional. The mass was completely resected through an open subcostal incision, with no encountered postoperative complications. A highlight of all published cases of adrenal hemangiomas since 1955 is also presented and reviewed.
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Licari L, Salamone G, Ciolino G, Campanella S, Parinisi Z, Sabatino C, Carfì F, Bonventre S, Gulotta G. The abdominal wall incisional hernia repair in cirrhotic patients. G Chir 2019; 39:20-23. [PMID: 29549677 DOI: 10.11138/gchir/2018.39.1.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The incidence of abdominal wall hernia in cirrhotic patients with ascites is between 20 and 40%. Controversies regarding the treatment modality and surgical timing of abdominal wall incisional hernia repair in cirrhotic patients remain. The study proposed wants to analyze the abdominal incisional hernia repair in cirrhotic patients with ascites performed in a single center to determine post-operative morbidity, mortality and complication rate. PATIENTS AND METHODS Cirrhotic patients with abdominal incisional hernia that underwent surgical operation for abdominal wall hernia repair at the "Policlinico Paolo Giaccone" at Palermo University Hospital between January 2015 and December 2016 were identified and the data collected were retrospectively reviewed; patients' medical and surgical records were collected from charts and the surgical and ICU registries. The degree of hepatic dysfunction was classified using Child-Pugh classification. Post-operative mortality was considered up to 30-days after surgery. A follow-up period of 6 months at least was performed to evaluate hernia recurrence and complications. RESULTS Mortality rate is of 18.5% (p 0.002). Recurrence rate (p 0.004) and seroma formation rate (p 0.001) are most frequent in urgency group. The elevated ASA score and the prediction of a complicated post-operative course is higher in urgency group (p 0.004) as higher is the in-hospital stay (p 0.001) and the ICU stay (p 0.001). CONCLUSIONS Elective surgery for abdominal wall hernia repair in cirrhotic patients seems to be successful and associated with lower mortality/morbidity rate and recurrence rate than urgency.
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Giambelluca D, Albano D, Giambelluca E, Bruno A, Panzuto F, Agrusa A, Di Buono G, Cannizzaro F, Gagliardo C, Midiri M, Lagalla R, Salvaggio G. Renal endometriosis mimicking complicated cysts of kidney: report of two cases. G Chir 2019; 38:250-255. [PMID: 29280706 DOI: 10.11138/gchir/2017.38.5.250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Endometriosis is a common gynecologic disorder characterized by ectopic endometrial tissue growth outside the uterine cavity. Although usually occurring in pelvic organs, endometrial lesions may involve urinary tract. Renal endometriosis is extremely rare and it has only occasionally been reported in the past. We report two cases of patients with renal cystic lesions, incidentally found at imaging techniques during oncologic follow-up for gastric sarcoma and melanoma, initially misinterpreted as complicated haemorrhagic cysts and then histologically characterized as renal localizations of extragenital endometriosis.
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Licari L, Salamone G, Parinisi Z, Campanella S, Sabatino C, Ciolino G, De Marco P, Falco N, Boventre S, Gulotta G. Multiparametric evaluation of risk factors associated to seroma formation in abdominal wall surgery. G Chir 2019; 38:280-284. [PMID: 29442058 DOI: 10.11138/gchir/2017.38.6.280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Incisional hernia is one of the main topics in the general surgery since there is not a unanimous consensus concerning to the best surgical methodology to adopt. It seems that prosthetic surgery is the best technique, even if responsible for the development of periprosthetic seroma. The aim of this study is to assess whether the preoperative abnormalities of the bio-humoral parameters may be considered as risk factors for seroma. PATIENTS AND METHODS From July 2016 to July 2017 at the "Policlinico Paolo Giaccone", Palermo, Department of Emergency Surgery, 56 patients included in this study, underwent laparotomic mesh repair. The inclusion criteria were: age > 18 years, incisional hernia W2R0 according to the Chevrel classification and a monoperator technique. The main variables were: sex, age, BMI, smoke, ASA score, and co-morbidities. Among the main serum-blood variables: natraemia, kalaemia, chloraemia, calcaemia, PCR, level of glucose, creatinine, albumin and proteins in the blood. The data were analyzed using SPSS software. RESULTS Univariate analysis highlighted hypo- and hyper-natraemia, hyper-kalaemia, hypo-chloraemia, high levels of PCR, hyper-glycemia, low level of serum-blood albumin and proteins, as statistically significant variables. Multivariate analysis revealed a p<0.05 for PCR, hypo-albuminemia and total serum-blood-protein level. CONCLUSIONS Alterations of pre-operative bio-humoral parameters could be associated to a greater risk of seroma development. A better understanding of such alterations may lead to more efficient risk stratification methods. This could be essential to better address the medical resources, reducing the post-operative complications and the outpatient controls as well as the risk associated to seroma.
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Jejunal GIST: Hunting down an unusual cause of gastrointestinal bleed using double balloon enteroscopy. A case report. Int J Surg Case Rep 2019; 60:303-306. [PMID: 31277041 PMCID: PMC6609737 DOI: 10.1016/j.ijscr.2019.06.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/07/2019] [Accepted: 06/24/2019] [Indexed: 12/22/2022] Open
Abstract
Bleeding jejunal GIST is very rare with only a handful of published case reports. Double-balloon enteroscopy and capsule endoscopy can be used to diagnose bleeding small intestine GIST. Occult small bowel bleeding can go undetected for years. Age is one of the determining factors for the type of small bowel pathology detected. Surgical resection remains the mainstay treatment for GIST. Laparoscopic surgery offers similar oncologic outcomes as an open surgery.
Introduction Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal neoplasms of the alimentary tract but accounts for only 0.1–3% of all gastrointestinal neoplasms. The most common presentation of GISTs is acute or chronic gastrointestinal bleeding, in which the patient presents with symptomatic anaemia. Presentation of case With that in mind, we describe a 66-year-old man who presented with recurrent episodes of obscure gastrointestinal bleeding for two years. Video capsule endoscopy (VCE) showed several small telangiectasias in the proximal small bowel. Oral route double-balloon enteroscopy (DBE) revealed abnormal mucosa 165 cm from incisor with central ulceration and vascular component. He subsequently underwent surgical excision. The histopathological report confirmed the diagnosis of GIST arising from the jejunum. During his clinic follow up, he remains symptom-free with no evidence of recurrence. Discussion The diagnosis of bleeding small intestine GISTs can be challenging as these are inaccessible by conventional endoscopy. Imaging modalities such as double-balloon enteroscopy, capsule endoscopy, CT angiography, intravenous contrast-enhanced multidetector row CT (MDCT) and magnetic resonance enterography (MRE) have been used to assist in the diagnosis of bleeding small intestine GISTs. The mainstay of management for small intestine GIST is complete surgical excision. Conclusion Bleeding jejunal GIST is very rare and only a handful of case reports have been published. The mainstay of management for small intestine GIST is complete surgical excision. It is essential to obtain a complete excision of localised disease and avoiding tumour spillage in order to reduce the risk of local recurrence and metastatic spread of GISTs.
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Agrusa A, Di Buono G, Buscemi S, Canfora I, Randisi B, Bonventre G, Gulotta L, Maienza E, Sorce V, Romano G, Gulotta G. Systemic schistosomiasis and large bowel perforation: An unexpected surgical urgency. Report of a case and literature review. Clin Case Rep 2019; 7:968-972. [PMID: 31110726 PMCID: PMC6509925 DOI: 10.1002/ccr3.2138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/10/2019] [Accepted: 03/12/2019] [Indexed: 12/28/2022] Open
Abstract
In the presence of suggestive clinical picture (high eosinophil count and multiple CT scan granuloma-like lesions), schistosomiasis should be taken into account in case of suspected bowel perforation even if common risk factors are not identified through anamnesis.
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Affiliation(s)
- Antonino Agrusa
- Section of General and Urgent Surgery, Department of Surgical, Oncological and Oral SciencesUniversity of PalermoPalermoItaly
| | - Giuseppe Di Buono
- Section of General and Urgent Surgery, Department of Surgical, Oncological and Oral SciencesUniversity of PalermoPalermoItaly
| | - Salvatore Buscemi
- Section of General and Urgent Surgery, Department of Surgical, Oncological and Oral SciencesUniversity of PalermoPalermoItaly
| | - Ilaria Canfora
- Section of General and Urgent Surgery, Department of Surgical, Oncological and Oral SciencesUniversity of PalermoPalermoItaly
| | - Brenda Randisi
- Section of General and Urgent Surgery, Department of Surgical, Oncological and Oral SciencesUniversity of PalermoPalermoItaly
| | - Giulia Bonventre
- Section of General and Urgent Surgery, Department of Surgical, Oncological and Oral SciencesUniversity of PalermoPalermoItaly
| | - Leonardo Gulotta
- Section of General and Urgent Surgery, Department of Surgical, Oncological and Oral SciencesUniversity of PalermoPalermoItaly
| | - Elisa Maienza
- Section of General and Urgent Surgery, Department of Surgical, Oncological and Oral SciencesUniversity of PalermoPalermoItaly
| | - Vincenzo Sorce
- Section of General and Urgent Surgery, Department of Surgical, Oncological and Oral SciencesUniversity of PalermoPalermoItaly
| | - Giorgio Romano
- Section of General and Urgent Surgery, Department of Surgical, Oncological and Oral SciencesUniversity of PalermoPalermoItaly
| | - Gaspare Gulotta
- Section of General and Urgent Surgery, Department of Surgical, Oncological and Oral SciencesUniversity of PalermoPalermoItaly
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Di Buono G, Buscemi S, Lo Monte AI, Geraci G, Sorce V, Citarrella R, Gulotta E, Palumbo VD, Fazzotta S, Gulotta L, Albano D, Galia M, Romano G, Agrusa A. Laparoscopic adrenalectomy: preoperative data, surgical technique and clinical outcomes. BMC Surg 2019; 18:128. [PMID: 31074390 PMCID: PMC7402565 DOI: 10.1186/s12893-018-0456-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background laparoscopic adrenalectomy has become the standard treatment for adrenal lesions. The better clinical outcoms of laparoscopic technique are valid for treatment of small benign masses (< 5–6 cm), instead there are still open questions in literature regarding the correct management of larger lesions (> 6 cm) or in case of potentially malignant adrenal tumors. The aim of this study is to evaluate the outcomes of laparoscopic adrenalectomy in a referral surgical department for endocrine surgery. Methods at the University Hospital Policlinico “P. Giaccone” of Palermo between January 2010 and December 2017 we performed a total of 81 laparoscopic adrenalectomy. We created a retrospective database with analysis of patients data, morphologic and hormonal characteristics of adrenal lesions, surgical procedures and postoperative results with histological diagnosis and complications. Results Mean size of adrenal neoplasm was 7,5 cm (range 1.5 to 18 cm). The mean operative time was 145 min (range 75–240). In statistical analysis lenght of surgery was correlated to the lesion diameter (p < 0.05) but not with pre-operative features or histological results. 5 intraoperative complications occurred. Among these patients 4 presented bleeding and 1 a diaphagmatic lesion. No conversion to open surgery was necessary and no intraoperative blood transfusion were required. Mean estimated blood loss was 95 ml (range 50–350). There was no capsular disruption during adrenal dissection. Mean length of hospital stay was 3.7 days (range 3–6 days). Conclusions Laparoscopic adrenalectomy is a safe procedure with low rate of morbidity. An accurate preoperative radiological examination is fundamental to obtain a stringent patients selection. The lesion diameter is related to longer operative time and appeares as the main predictive parameter of intraoperative complications but these results are not statistically significant. On the other side secreting adrenal tumors require more attention in operative management without increased rate of postoperative complications.
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Affiliation(s)
- Giuseppe Di Buono
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy.
| | - Salvatore Buscemi
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Attilio Ignazio Lo Monte
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Girolamo Geraci
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Vincenzo Sorce
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Roberto Citarrella
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | - Eliana Gulotta
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Vincenzo Davide Palumbo
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Salvatore Fazzotta
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Leonardo Gulotta
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Domenico Albano
- Department of Radiology, University of Palermo, Palermo, Italy
| | - Massimo Galia
- Department of Radiology, University of Palermo, Palermo, Italy
| | - Giorgio Romano
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Antonino Agrusa
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy
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Agrusa A, Di Buono G, Buscemi S, Randisi B, Gulotta L, Sorce V, Badalamenti G, Albano D, Galia M, Romano G, Gulotta G. Dedifferentiated retroperitoneal large liposarcoma and laparoscopic treatment: Is it possible and safe? The first literature case report. Int J Surg Case Rep 2019; 57:113-117. [PMID: 30947065 PMCID: PMC6446056 DOI: 10.1016/j.ijscr.2019.03.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/26/2019] [Accepted: 03/18/2019] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Soft tissue sarcomas are rare neoplasms often characterized by local invasiveness and distant metastasis with poor prognosis for affected patients. Among the most frequent sarcomas we find well-differentiated and dedifferentiated liposarcomas characterized by a better survival compared to the other histological types. When it is possible the only curative treatment for these neoplasms is surgical resection. CASE REPORT We report a case of a 62-year-old caucasian woman with CT abdominal scan that demonstrated a voluminous solid oval mass in the left perirenal space with dislocation of the kidney and in continuity with the anterior renal fascia. After a percutaneous CT-guided biopsy of the mass the histopathological diagnosis was a dedifferentiated retroperitoneal liposarcoma. We performed a laparoscopic surgical resection of the retroperitoneal mass in block with kidney and left adrenal gland. DISCUSSION When possible, surgical resection with adequate margins represents the only curative therapeutic option for this pathology. Only a few papers are available in literature which take into consideration the possibility of laparoscopic approach for retroperitoneal masses with better vision of surgical field, reduction of post-operative pain and better cosmesis. CONCLUSION A retroperitoneal mass represents a serious diagnostic challenge. The choice of the best surgical procedure can benefit to the patient prognosis. To our opinion laparoscopy can be a safe and successful treatment and it can represent a valid alternative to open surgery. However, we have no randomized controlled trials that compare laparoscopic versus open resection for retroperitoneal liposarcomas.
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Affiliation(s)
- Antonino Agrusa
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Giuseppe Di Buono
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Salvatore Buscemi
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Brenda Randisi
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Leonardo Gulotta
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Vincenzo Sorce
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Giuseppe Badalamenti
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Italy.
| | - Domenico Albano
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Massimo Galia
- Department of Radiology, University of Palermo, Palermo, Italy.
| | - Giorgio Romano
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Gaspare Gulotta
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
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Albano D, Agnello F, Midiri F, Pecoraro G, Bruno A, Alongi P, Toia P, Di Buono G, Agrusa A, Sconfienza LM, Pardo S, La Grutta L, Midiri M, Galia M. Imaging features of adrenal masses. Insights Imaging 2019; 10:1. [PMID: 30684056 PMCID: PMC6349247 DOI: 10.1186/s13244-019-0688-8] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/03/2019] [Indexed: 12/14/2022] Open
Abstract
The widespread use of imaging examinations has increased the detection of incidental adrenal lesions, which are mostly benign and non-functioning adenomas. The differentiation of a benign from a malignant adrenal mass can be crucial especially in oncology patients since it would greatly affect treatment and prognosis. In this setting, imaging plays a key role in the detection and characterization of adrenal lesions, with several imaging tools which can be employed by radiologists. A thorough knowledge of the imaging features of adrenal masses is essential to better characterize these lesions, avoiding a misinterpretation of imaging findings, which frequently overlap between benign and malignant conditions, thus helping clinicians and surgeons in the management of patients. The purpose of this paper is to provide an overview of the main imaging features of adrenal masses and tumor-like conditions recalling the strengths and weaknesses of imaging modalities commonly used in adrenal imaging.
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Affiliation(s)
- Domenico Albano
- Unità di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
| | - Francesco Agnello
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Federico Midiri
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Giusy Pecoraro
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Alberto Bruno
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Pierpaolo Alongi
- Department of Radiological Sciences, Nuclear Medicine Service, Fondazione Istituto G. Giglio, Contrada Pietrapollastra-Pisciotto, 90015, Cefalu, Italy
| | - Patrizia Toia
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Giuseppe Di Buono
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Antonino Agrusa
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Luca Maria Sconfienza
- Unità di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Salvatore Pardo
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Ludovico La Grutta
- Department PROMISE, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Massimo Midiri
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Massimo Galia
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
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Abstract
Background Adrenal cavernous hemangiomas are very rare benign tumors that usually present as incidental findings on abdominal imaging. Preoperative differential diagnosis from other benign or malignant adrenal neoplasms may be challenging. Case presentation A 70-year old man was referred for an 8-cm abdominal mass incidentally discovered on a contrast-enhanced computed tomography (CT) performed to investigate a pulmonary nodule. Biochemical tests ruled out any endocrine dysfunction and iodine 123 metaiodobenzylguanidine whole body scintiscan single-photon emission CT excluded a pheocromocitoma. Findings on magnetic resonance imaging were non-specific and the patient was elected for a left adrenalectomy. Histopathological diagnosis revealed a cavernous hemangioma. A portion of the resected tissue was tested for drug sensitivity to mitotane, doxorubicin, and sunitinib. Conclusions Adrenal hemangioma is a rare disease but should be included in the differential diagnosis of adrenal tumors. The surgical resection is generally required to exclude malignant disease, resolve pressure-related symptoms, and prevent retroperitoneal hemorrhage. Although specific features in diagnostic imaging are often lacking, if the diagnosis is established preoperatively a laparoscopic adrenalectomy can be performed due to the benign nature of the lesion. Doxorubicin and sunitinib were both capable of reducing primary culture cell viability, this suggest that similar drugs may be useful in the medical treatment of adrenal hemangiomas.
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Peng X, Luo W, Zhang X, Zhu W. Sudden onset flank pain: a case report of retroperitoneal hemorrhage secondary to a ruptured adrenal hemangioma. J Pain Res 2018; 11:1421-1424. [PMID: 30104897 PMCID: PMC6074836 DOI: 10.2147/jpr.s160661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Acute abdominal pain is a common complaint of patients presenting at the emergency department (ED). It can be caused by a broad spectrum of diseases. Providing care for patients with acute abdominal pain requires familiarity with the epidemiology, prevalence, and presentation of abdominal pathology, as well as a working knowledge of the differential diagnoses. CASE REPORT In this article, we discuss a case of spontaneous rupture of adrenal hemangioma with large retroperitoneal hemorrhage in a 31-year-old female. DISCUSSION Emergency physicians regularly encounter uncommon causes of abdominal pain. Spontaneous rupture of adrenal hemangioma is an extremely rare cause of abdominal pain, but proper understanding of the disease process will aid clinicians to make a final diagnosis and ensure appropriate treatment. In this study, presentations and risk factors for spontaneous, atraumatic rupture of adrenal hemangioma as well as ED management and definitive treatment options are discussed.
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Affiliation(s)
- Xufeng Peng
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China,
- Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China,
| | - Wenqiang Luo
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China,
- Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China,
| | - Xinru Zhang
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China,
- Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China,
| | - Weidong Zhu
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China,
- Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China,
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Agrusa A, Di Buono G, Buscemi S, Cucinella G, Romano G, Gulotta G. 3D laparoscopic surgery: a prospective clinical trial. Oncotarget 2018; 9:17325-17333. [PMID: 29707111 PMCID: PMC5915119 DOI: 10.18632/oncotarget.24669] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/27/2018] [Indexed: 12/24/2022] Open
Abstract
Since it's introduction, laparoscopic surgery represented a real revolution in clinical practice. The use of a new generation three-dimensional (3D) HD laparoscopic system can be considered a favorable "hybrid" made by combining two different elements: feasibility and diffusion of laparoscopy and improved quality of vision. In this study we report our clinical experience with use of three-dimensional (3D) HD vision system for laparoscopic surgery. Between 2013 and 2017 a prospective cohort study was conducted at the University Hospital of Palermo. We considered 163 patients underwent to laparoscopic three-dimensional (3D) HD surgery for various indications. This 3D-group was compared to a retrospective-prospective control group of patients who underwent the same surgical procedures. Considerating specific surgical procedures there is no significant difference in term of age and gender. The analysis of all the groups of diseases shows that the laparoscopic procedures performed with 3D technology have a shorter mean operative time than comparable 2D procedures when we consider surgery that require complex tasks. The use of 3D laparoscopic technology is an extraordinary innovation in clinical practice, but the instrumentation is still not widespread. Precisely for this reason the studies in literature are few and mainly limited to the evaluation of the surgical skills to the simulator. This study aims to evaluate the actual benefits of the 3D laparoscopic system integrating it in clinical practice. The three-dimensional view allows advanced performance in particular conditions, such as small and deep spaces and promotes performing complex surgical laparoscopic procedures.
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Affiliation(s)
- Antonino Agrusa
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Giuseppe Di Buono
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Salvatore Buscemi
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Gaspare Cucinella
- Department of Obstetrics and Gynecology, University of Palermo, Palermo, Italy
| | - Giorgio Romano
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Gaspare Gulotta
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
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Agrusa A, Romano G, Navarra G, Conzo G, Pantuso G, Buono GD, Citarrella R, Galia M, Monte AL, Cucinella G, Gulotta G. Innovation in endocrine surgery: robotic versus laparoscopic adrenalectomy. Meta-analysis and systematic literature review. Oncotarget 2017; 8:102392-102400. [PMID: 29254254 PMCID: PMC5731964 DOI: 10.18632/oncotarget.22059] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/23/2017] [Indexed: 01/11/2023] Open
Abstract
Several studies in the last years demonstrated the better surgical outcome of laparoscopic approach to adrenal gland. Laparoscopic surgery is more difficult to learn and requires different psychomotor skills than open surgery, especially with regard to complex maneuvers requiring precision and dexterity. The development of robotic platform with three-dimensional vision and increased degrees of freedom of the surgical instruments has the aim to overcome these problems. We performed a systematic literature review with meta-analysis to evaluate preoperative data and surgical outcomes of robotic adrenalectomy compared with laparoscopic technique. In September 2016 we performed a systematic literature review using the Pubmed, Scopus and ISI web of knowledge database with search term “robotic adrenalectomy”. We identified 13 studies with eligible criteria that compared surgical outcomes. This present systematic review with meta-analysis includes 798 patients: 379 underwent to robotic adrenalectomy (cases group) and 419 to laparoscopic adrenalectomy (controls group). There were no significant differences between the two groups of patients respect to age, gender, laterality and tumor size. BMI instead was significant lower in the robotic group. In this group we found also patients with higher incidence of previous abdominal surgery. The results from operative time demonstrated lower operative time for laparoscopic group but there were no significant differences with robotic group. Robotic adrenalectomy showed a significant lower blood loss. Robotic adrenalectomy is a safe and feasible technique with reduced blood loss and shorter hospital stay than laparoscopic adrenalectomy. Laparoscopic approach seems to be a more rapid technique when comparing to robotic technique, although recent studies demonstrate a significant operative time reduction in robotic group with the learning curve improvement and the development of new surgical technology.
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Affiliation(s)
- Antonino Agrusa
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Palermo, Italy
| | - Giorgio Romano
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Palermo, Italy
| | - Giuseppe Navarra
- Department of Human Pathology University Hospital of Messina, Messina, Italy
| | - Giovanni Conzo
- Department of Anesthesiologic, Surgical and Emergency Sciences, Division of General and Oncologic Surgery, School of Medicine, Second University of Naples, Naples, Italy
| | - Gianni Pantuso
- Department of Surgery and Oncology, University of Palermo, Palermo, Italy
| | - Giuseppe Di Buono
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Palermo, Italy
| | - Roberto Citarrella
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | - Massimo Galia
- Section of Radiology - Di.Bi.Me.F., University of Palermo, Palermo, Italy
| | - Attilio Lo Monte
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Palermo, Italy
| | - Gaspare Cucinella
- Department of Obstetrics and Gynecology, University of Palermo, Palermo, Italy
| | - Gaspare Gulotta
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Palermo, Italy
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Albano D, Sinagra E, Patti C, Narese D, Agrusa A, Di Buono G, Raimondo D, Midiri M, Lagalla R, Galia M. Caecal leiomyoma detected by whole-body MRI in a patient with Hodgkin lymphoma: first case report. G Chir 2017; 38:27-32. [PMID: 28460200 DOI: 10.11138/gchir/2017.38.1.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Hodgkin Lymphoma (HL) is one of the most curable malignant diseases. Modern treatments, like the combined radiochemotherapy and stem cell transplantation, have increased the number of malignant disease survivors. However, HL survivors are at risk of long-term effects, including the development of solid tumors. Secondary neoplasms are a major cause of late morbidity and mortality following treatment for HL. CASE REPORT We report the case of a male patient, treated for HL by chemotherapy, who developed a large leiomyoma of the cecum one year after the treatment. A whole-body Magnetic Resonance (WBMRI) scan performed during the follow-up allowed the detection of this incidental caecal mass that was absent in a Computed Tomography (CT) scan performed immediately after the treatment. After a CT-guided biopsy, the lesion was surgically removed and the diagnosis of caecal leiomyoma was obtained. DISCUSSION To our knowledge, this is the first case report, according to the scientific literature, of caecal leiomyoma developing after chemotherapy in a HL survivor. Leiomyoma is a rare benign tumor that usually appears as a solitary small mass with a nodular growth and a benign course. CONCLUSION This case shows that WB-MRI allows detecting relevant incidental findings during the oncologic follow-up, avoiding both radiation exposure and contrast agent administration. Furthermore, leiomyoma should be considered in the differential diagnosis between the caecal masses with high growth rate.
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Cucinella G, Calagna G, Romano G, Di Buono G, Gugliotta G, Saitta S, Adile G, Manzone M, Accardi G, Perino A, Agrusa A. Robotic versus laparoscopic sacrocolpopexy for apical prolapse: a case-control study. G Chir 2017; 37:113-117. [PMID: 27734794 DOI: 10.11138/gchir/2016.37.3.113] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The apical prolapse has always been considered the most complex of the defects of the pelvic floor, for both the difficulty of the surgical corrective technique and for the high post-surgical recurrence rate. Today, the laparoscopic sacrocolpopexy can be considered the standard treatment for apical prolapse. In the last years, several author performed robotic sacrocolpopexy, obtaining positive results. So, we developed a casecontrol study in order to compare the surgical outcome of robotic group with a control group of laparoscopic approach in patients with symptomatic apical pro-lapsed between January 2015 and December 2015 at University Hospital Policlinico "P. Giaccone" and Ospedali Riuniti "Villa Sofia-Cervello", Palermo. Our experience shows that robotic sacrocolpopexy can be considered in positive way for clinical results obtained: all procedures were executed with no complications, we noted a lower intraoperative blood loss and a shorter hospital stay than in laparoscopic group. Although the mean operative time and the economic costs are higher in robotic surgery, this study demonstrates that the use of robotic platform for repairing of symptomatic apical vaginal prolapse is feasible, safe and associated with short-term satisfactory results, representing therefore a valid alternative to laparoscopic approach.
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