Laparoscopic adrenalectomy for giant pheochromocytoma. What is the size limit ?

AIM: This case report describes a giant pheochromocytoma in a young female, experienced cardiac symptoms, treated by a transperitoneal laparoscopic right adrenalectomy. MATERIAL AND METHODS: A 29 years old female with Taki-tsubo syndrome, consequent to the chronic release of catecholamines, with a palpable abdominal mass and vague abdominal symptoms was referred to our department. Abdominal CT scan has demonstrated a solid mass of 13 cm in the right adrenal space so, after pre-operative management with alpha-adrenergic receptor and beta blockade and a 3D CT scan reconstruction a right adrenalectomy laparoscopic approach was performed. RESULTS: Our result underlines that 13 cm in size for a giant pheochromocytoma is not an absolute contraindication to perform a minimally invasive approach in expert hands, with optimal surgical, oncological and cosmetic results. DISCUSSION: The only curative option for non-metastatic pheochromocytomas disease is surgical resection. Laparoscopic adrenalectomy is the treatment of choice but the limit size for a safe and feasible minimally invasive approach is not yet defined. CONCLUSIONS: This case report could help to better define more solid recommendations in the next future and also provide landmarks and key steps for laparoscopic surgeons. KEY WORDS: Giant Pheochromocytoma, Laparoscopic Adrenalectomy, Pheochromocytoma Management.

Could Stoma Be Avoided after Laparoscopic Low Anterior Resection for Rectal Cancer? Experience with Transanal Tube in 195 Cases.

Anastomotic leakage is the most-feared complication of rectal surgery. Transanal devices have been suggested for anastomotic protection as an alternative to defunctioning stoma, although evidence is conflicting, and no single device is widely used in clinical practice. The aim of this paper is to investigate the safety and efficacy of a transanal tube for the prevention of leakage following laparoscopic rectal cancer resection. A transanal tube was used in the cases of total mesorectal excision with low colorectal or coloanal anastomosis, undamaged doughnuts, and negative intraoperative air-leak test. The transanal tube was kept in place until the seventh postoperative day. A total of 195 consecutive patients were retrieved from a prospective surgical database and included in the study. Of these, 71.8% received preoperative chemoradiotherapy. The perioperative mortality rate was 1.0%. Anastomotic leakage occurred in 19 patients, accounting for an incidence rate of 9.7%. Among these, 13 patients underwent re-laparoscopy and ileostomy, while 6 patients were managed conservatively. Overall, the stoma rate was 6.7%. The use of a transanal tube may be a suitable strategy for anastomotic protection following restorative rectal cancer resection. This approach could avoid the burden of a stoma in selected patients with low anastomoses.