40 - Hauptsitzung
16. Mai 2019, 08:30 - 10:15, Bellavista 5, 6. OG
Assessment of remnant viability in posterior retroperitoneoscopic partial adrenalectomy in a preclinical model
B. Seeliger1, 2, M. K. Walz2, P. F. Alesina2, R. Pop1, A.-L. Charles1, B. Geny1, P. Mascagni1, E. Seyller1, M. Barberio1, V. Agnus1, J. Marescaux1, M. Diana1, Presenter: B. Seeliger1, 2 (1Strasbourg/FR, 2Essen/DE)
A surgical approach preserving functional adrenal tissue, unilaterally or bilaterally, allows to achieve a biochemical cure while preventing the necessity for lifelong steroid replacement. The aim of this experimental acute study was to evaluate the impact of partial adrenalectomy on the remnant adrenal gland perfusion and function.
Five pigs underwent bilateral posterior retroperitoneoscopic central division of the adrenal glands into a cranial and a caudal segment (n=9, plus one intact control gland). Intraoperative assessment tools for remnant perfusion included computer-assisted quantitative fluorescence imaging, local lactate sampling, and computed tomography (CT). CT-scans from 3 randomly selected pigs (6 intact adrenal glands) in our database served as controls for CT analysis. Following intraoperative assessments, bilateral retroperitoneoscopic completion adrenalectomy was performed (n=10). The postoperative specimen analysis integrated mitochondrial activity using the oxygraphic method.
Mean logarithmic fluorescence intensity signal evolution over time (40 s) was significantly lower in the cranial (0.27±0.37) as compared to the caudal (0.79±0.2) segment of each adrenal gland (p=0.0195). Evaluation of intraoperative CT in the portal phase demonstrated a significantly lower contrast uptake in the cranial segments as compared to caudal segments in divided glands versus intact glands (mean difference -40.0HU vs. 1.2HU, p=0.009). These imaging findings suggesting decreased perfusion in the cranial segment were congruent with significantly higher mean local capillary lactate levels in the cranial adrenal segment (11.58±6.53 cranially vs. 5.66±5.79 caudally) (p=0.0388). Mitochondrial respiration rates did not show any statistically significant difference between different intervals for completion adrenalectomy (1.75-4.3h), nor between the cranial and caudal segments.
After adrenal gland division, quantitative fluorescence imaging, CT and local lactate sampling could discriminate between regular and reduced perfusion of adrenal remnants. However, those intraoperative measurements could not exactly predict the degree of function preservation. The mitochondrial function in each half of the adrenal glands was preserved up to 4.3 hours after gland transection. The correlation between remnant perfusion and long-term viability is currently being investigated.