CT-PLANNING ACCESS FOR ADRENALECTOMY

Abstract

Aim: to determine the possibilities of modern multislice computed tomography in the preoperative planning of a rational variant of surgical access to the adrenal gland with a tumor. Materials and methods: the results of the examination and treatment of 1196 patients with surgical diseases of the adrenal glands (AG) were studied. The virtual-figurative design of a rational variant of surgical access to AG with a tumor was carried out in 362 patients after evaluating the features of their topographic-anatomical location according to CT-scan. The criterion for the inclusion of patients in the study was the ability to perform after 2013 multislice computed tomography (MSCT) with intravenous contrast on the modern installation Aquillion 64 (Toshiba, Japan) and subsequent post-processing of images with the construction of multiplane and 3D reconstructions. Results: studying the features of the topographic-anatomical location of AGs with a tumor using MSCT allowed us to form a virtual-figurative perception of their syntopy in 362 patients and to design options for access to perform adrenalectomy (AE): retroperitoneoscopic (n = 303), laparoscopic (n = 25), thoracophrenotomy ( n = 30), thoracophrenolaparotomic (n = 5). 363 surgical interventions were performed for 362 patients. A single-sided retroperitoneoscopic AE for pheochromocytoma was performed in 1 patient. Reliable CT criteria were determined that affect the duration and safety of the above-mentioned accesses performed by AEs. It has been established that when designing access to the right AG, it is necessary to consider: the diameter of the neoplasm; the location of the AG with a tumor relative to the inferior vena cava and the lower right hepatic vein; contact with vessels in the gate of the kidney, as well as the presence of additional central veins AG. The determining factors in planning access to the left AG are: neoplasm diameter, contact with vessels in the gate of the kidney and splenic vessels, location in the aorto-renal vascular triangle. It was established that retroperitoneoscopic AE, performed in 83.7% of patients with AG tumors with a diameter of ≤ 8 cm, is an operation of choice. Laparoscopic access remains relevant only when the right-sided localization of an AG tumor with a diameter of up to 8 cm and planning simultaneous surgical interventions on the abdominal organs in individuals of a brachymorphic physique (8.3%). Open approaches are shown in benign lesions of the AG more than 8 cm in diameter, generalized forms of adrenocortical cancer (ACC) (T3-4N0-2M0-1), malignant paragangliomas with signs of invasion or distant metastasis (n = 9.7%). Conclusions: multispiral computed tomography allows, before the operation, to carry out adequate planning of the safest surgical access for adrenalectomy, avoiding the development of intra- and postoperative complications, minimizing operative trauma, shortening the operating time, and speeding up the medical and social rehabilitation of patients.