mets to adrenal gland and renal artery

vickyc

2nd mets after 7 yrs, this time in adrenal gland surrounding renal artery and atached to diaphram- symtoms of pressure under right ribcage and back (not pain but intermittent pressure) has anyone else had this type mets and what are they doing for it

snowyday

Minimally Invasive European Adrenalectomy Approach Reaches U.S. Hope you get something out of this it's the most info I could find on adrenal mets.  vicky sorry your going through this, and I hope this answer helps a bit.  I had cysts on each kidney right where the adrenals are so I too am searching for answers.  Good luck. I am wondering what is happening with me my underarms and groin and neck are all swollen and when I lay flat on my back I get spasms of pain in my kidneys, sort  of like the begining of labour pains.  Just had an ultra sound done on my groin and underarms and when the Tech was doing the scan we had to stop at least five times so I could wait out the kidney spasms, to me it feels like someone is going right in there and grabbing my kidneys and slowly letting them go.  Sick of being sick and I really believed that if I moved it would all just disapear, how silly.  Here is your info maybe you could pick out certain sections and go to emedicine or Bing and google them and find more answers.  Prayers going your way.Elsevier Global Medical News. 2008 Jun 16, B JancinNEW YORK (EGMN) - Posterior retroperitoneoscopic adrenalectomy is a safe and attractive option for minimally invasive removal of benign adrenal tumors and isolated adrenal metastases, according to the experience of surgeons at the University of Texas M.D. Anderson Cancer Center, Houston.In the first 62 patients at the center to have adrenal glands removed via the posterior procedure, the average operative time was 2 hours for unilateral cases, with a median hospital stay of 2 days. The procedure proved especially useful for patients who had extensive abdominal adhesions from prior surgery, as well as for those undergoing bilateral adrenalectomy. Outcomes for obese patients were as good as for the rest of the group. The posterior procedure "has become our routine practice and our approach of choice in the majority of patients who require adrenalectomy," Dr. Nancy D. Perrier of M.D. Anderson said at the annual meeting of the American Surgical Association.Outside of M.D. Anderson, the operation is not often done in the United States. Its leading proponent is Dr. Martin K. Walz of the University of Essen (Germany). Three endocrine surgeons from M.D. Anderson who saw Dr. Walz's presentation in New York City of his 560-procedure, 520-patient series were so impressed that they traveled to Germany to learn his techniques. In his series, the mean operating time was 67 minutes, blood loss was 10 mL, and the major complication rate was 1.3% (Surgery 2006;140:943-8). The surgeons then brought him to Houston to provide further guidance. Dr. Walz, a surgical innovator, introduced two major advances in posterior retroperitoneoscopic adrenalectomy. He established the safety of using CO2 insufflation pressures that are double the usual 10-12 mm Hg utilized in abdominal operations; these high pressures create a much larger space for dissection, and make for excellent visualization by essentially eliminating venous bleeding. He also showed that freeing the gland from the kidney as an early step, and leaving the adrenal hanging from its superior attachment, made dissection of the gland easier and safer, explained Dr. Perrier, an endocrine surgeon at M.D. Anderson.Patient positioning is a key aspect of the procedure. The patient is put to sleep in the supine position, then turned to a prone jackknife position atop a ventral rectangular support on the operating table to allow for maximum distention between the 12th rib and iliac crest. This lets the abdominal wall contents hang freely, permitting a significant amount of insufflation without negative pressure. A 10-mm port is placed below the tip of the 12th rib, a second one is placed medially, and a 5-mm trocar is placed laterally.The next important part of the operation is to obtain familiar anatomic landmarks, including the superior pole of the kidney, the inferior vena cava, and the blue-hued liver. Then comes the critical move: elevating the inferior pole of the adrenal off of the superior pole of the kidney as it is retracted inferiorly; this allows the gland to suspend from the retroperitoneal fibrous adhesions, permitting its easy dissection, the surgeon continued.She reported on the first 68 adrenal glands removed from 62 patients via posterior retroperitoneoscopic adrenalectomy at M.D. Anderson. Thirty-three were unilateral procedures. Most of the patients had pheochromocytomas. One-quarter had metastatic lesions, mostly from the lung. Thirty-four patients had extensive adhesions from prior abdominal operations, so the transabdominal approach was contraindicated.The mean tumor size was 3.3 cm. The Houston group will not use posterior retroperitoneoscopic adrenalectomy for tumors larger than 6 cm because the prevalence of primary malignancy in such tumors is at least 25%.The mean operative time was 2 hours for unilateral cases, with a median 2-day hospital day. There were 11 complications, consisting of 6 intraoperative conversions and 5 postoperative complications, including acute respiratory distress and retroperitoneal hematoma. Results among patients in the first half of the series were similar to those in the second half.Dr. Quan-Yang Duh commented that although he adopted transabdominal laparoscopic adrenalectomy as his standard approach in the 1990s, he has long thought that posterior retroperitoneoscopic adrenalectomy sounded more attractive for patients with extensive abdominal adhesions from prior surgery and for those requiring bilateral adrenalectomy.But it's a complex operation. The anatomy can be confusing because of the unfamiliar posterior approach Dr. Duh, professor of surgery at the University of California, San Francisco, asked about the difficulty of teaching this operation to trainees.Dr. Perrier replied that she and her colleagues believe posterior retroperitoneoscopic adrenalectomy is best left in the hands of endocrine surgeons, who will be making the procedure a substantial part of their careers. A general surgeon who might perform only one or two per year will not be able to become facile at it, so she is not teaching it to them.Dr. Richard A. Prinz said the posterior approach should be used with caution in patients with extensive retroperitoneal fat.