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VR-34
(VS)
LAPAROSCOPIC RESECTION OF HIGH RISK ADRENAL NEUROBLASTOMA BY
POSTERIOR APPROACH FOLLOWING CHEMOTHERAPY
Haytham BADAWY
1
, Salah NAGLAA
2
, Ahmed ABULFOTOOH EID
1
, Waleed DAWOOD
1
, Amr KAMAL
1
, Khaled RIFAAI
1
and
Akram ASSEM
1
1) Faculty of medicine, university of alexandria, Department of urology, Alexandria, EGYPT - 2) Faculty of medicine,
university of tanta, Department of urology, Tanta, EGYPT
PURPOSE
laparoscopic adrenalectomy by posterior approach carries high recovery and shorter operative time. Children with
metastatic high risk neuroblastoma arising from the suprarenal gland should undergo local surgical excision of the
primary tumor before further intensification of chemotherapy and possible bone marrow transplantation. Herein, we
report a video of left laparoscopic adrenalectomy showing the different steps of the procedure.
MATERIAL AND METHODS
3.8 y old boy with left metastatic suprarenal neuroblastoma, received chemotherapy according to high risk European
protocol. Child positioned in prone position, first trocar at the tip of the last rib by open introduction, two 5mm trocars
one in costovertebral angle and the other is lateral. Balloon development of the space, gerota fascia opened, the upper
pole of kidney identified, mass dissected, suprarenal vein is clipped during dissection, extraction in bag.
RESULTS
oral feeding is begun after 6 hours, discharge from hospital in the second day postoperatively, rapid convalescence,
rapid resumption of chemotherapy.
CONCLUSIONS
laparoscopic adrenalectomy using posterior approach gives direct access to the adrenal gland, no peritoneal violation,
rapid intestinal movement recovery, short hospital stay and rapid recovery. All advantages that might facilitate the early
start of adjuvant chemotherapy in children with neuroblastoma, however, oncological outcome should be proven by long
term follow up, larger number of patients, and good selection of small tumor facilitates surgical extirpation.