Laparoscopic management of renal hilar pheochromocytomas

Although laparoscopic adrenalectomy is well established for the treatment of adrenal pheochromocytomas, there is scant literature on a laparoscopic approach to extra-adrenal pheochromocytomas (EAP). We report on 2 patients with renal hilar pheochromocytomas treated by a laparoscopic resection. A 56-year-old hypertensive man was found to have a 3.5-cm tumor in the right renal hilum, which was confirmed to be a pheochromocytoma on the basis of elevated urinary vanillylmandelic acid levels and a positive 131I-MIBG scan. After pharmacological preparation, he underwent a laparoscopic excision. The recovery was uneventful and the final histopathology confirmed an EAP. The second patient, a 17-year-old hypertensive girl, was shown to have a 2.5-cm tumor in close proximity to the left renal vessels and a poorly functioning left kidney on a computed tomography scan. Subsequent isotope renogram showed 4% function in the left kidney. After adequate preparation, she underwent a laparoscopic left nephrectomy along with resection of the tumor. The postoperative period was uneventful. Histopathology showed an EAP. The kidney showed ischemic changes along with severe renal artery stenosis. The patients remain well 49 and 14 months post-surgery. In conclusion, careful preoperative preparation, expert intraoperative anesthetic management, and surgery performed by an experienced surgeon make laparoscopic resection of renal hilar pheochromocytomas a safe and feasible treatment option.