Laparoscopic removal of pheochromocytoma. Why? When? and Who? (reflections on one case report)

Until now, the need for wide exposure and nonmanipulative dissection of pheochromocytoma has dictated the use of a large intraperitoneal transabdominal approach, which unfortunately results in a significant incidence of morbidity. A unilateral retroperitoneal approach guided by the refinements of new imaging techniques is less invasive but is associated with a small risk of incomplete cure. In one case report, we tested the hypothesis that laparoscopic surgery could combine the beneficial effects of both operative strategies without their respective side effects. We concluded that a laparoscopic approach combined with exclusive intraoperative infusion of nicardipine, a calcium-channel blocker, can be used to surgically remove pheochromocytoma under stable hemodynamic conditions. This provides better exposure of the anatomical structures than open surgery and allows a visual exploration of the entire abdominal cavity to exclude tumor multicentricity or ectopic sites in the case of inconclusive preoperative imaging investigations. Moreover, conversion to open surgery is always possible if needed.