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Non-invasive measurements of cardiac output (CO), systemic vascular resistance (SVR), corrected aortic flow time (FTc) and stroke volume (SV) are useful parameters during laparoscopic resection of pheochromocytoma (adrenalectomy) to document the intraoperative changes in volume status and to estimate the volume depletion.
Pheochromocytomas and extraadrenal paragangliomas are catecholamin-producing tumours deriving from the adrenal medulla and sympathetic ganglia. The only causal therapy is surgical resection. Nowadays, laparoscopic adrenalectomy is thought to be the optimal approach. Chronic volume depletion due to chronic hypertension and preoperative α-adrenoreceptor-blockade (to avoid the effects of intraoperative catecholamine-excess) often lead to hypotension after resection of the tumour. Volume reload with high amounts of fluid is often needed. Therefor some authors recommended invasive measurement (pulmonary artery catheter) to control cardiac output parameters and fluid balance. However, there are non-invasive methods to measure cardiac output(CO), systemic vascular resistance(SVR), stroke volume(SV) and corrected aortic flow time(FTc) to estimate volume status. Except transesophageal echocardiography, other techniques such as transoesophageal doppler and pulse pressure methods exist but have not been investigated during surgical therapy for pheochromocytoma so far. The esophageal Doppler currently represents the "gold standard" for perioperative fluid replacement therapy.
The study's hypothesis is that non-invasive measurements of cardiac output (CO), systemic vascular resistance (SVR), corrected aortic flow time (FTc) and stroke volume (SV) are useful parameters during laparoscopic resection of pheochromocytoma (adrenalectomy) to document the intraoperative changes in volume status and to estimate the volume depletion.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Pheochromocytoma Group | Intraoperative esophageal doppler sonography during laparoscopic adrenalectomy performed for pheochromocytoma | ||
| Control group | Intraoperative esophageal doppler sonography during laparoscopic adrenalectomy for non-pheochromocytoma adrenal tumor |
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| Measure | Description | Time Frame |
|---|---|---|
| Cardiac output (CO) | measured using esophageal doppler | parameter will be measured continously for the duration of adrenalectomy, an expected average of 3 hours |
| Systemic vascular resistance (SVR) | measured using esophageal doppler | parameter will be measured continously for the duration of adrenalectomy, an expected average of 3 hours |
| Stroke volume (SV) | measured using esophageal doppler | parameter will be measured continously for the duration of adrenalectomy, an expected average of 3 hours |
| Corrected aortic flow time(FTc) | measured using esophageal doppler | parameter will be measured continously for the duration of adrenalectomy, an expected average of 3 hours |
| Central venous pressure | Measured using esophageal doppler | parameter will be measured continously for the duration of adrenalectomy, an expected average of 3 hours |
| Heart rate | parameter will be measured continously for the duration of adrenalectomy, an expected average of 3 hours | |
| Arterial blood pressure | systolic, diastolic, mean; continuous invasive measurement | parameter will be measured continously for the duration of adrenalectomy, an expected average of 3 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Changes in serum Concentration: Epinephrine | 7 timepoints during anesthesia (Administration of rocuronium, intubation, cut, intraabdominal air insufflation, ligature of v. suprarenalis, tumor exstirpation, end of operation) | |
| Changes in serum concentration: Norepinephrine |
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Inclusion Criteria:
Exclusion Criteria:
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Patients suffering from pheochromocytoma will be recruited by the Department of Surgery, Medical University of Vienna
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| Name | Affiliation | Role |
|---|---|---|
| Martin B Niederle, MD, DMedSc | Medical University of Vienna | Principal Investigator |
| Edith Fleischmann, Prof, MD | Medical University of Vienna | Study Chair |
| Bruno Niederle, Prof, MD | Medical University of Vienna | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Medical University of Vienna | Vienna | 1050 | Austria |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 30976898 | Derived | Niederle MB, Fleischmann E, Kabon B, Niederle B. The determination of real fluid requirements in laparoscopic resection of pheochromocytoma using minimally invasive hemodynamic monitoring: a prospectively designed trial. Surg Endosc. 2020 Jan;34(1):368-376. doi: 10.1007/s00464-019-06777-z. Epub 2019 Apr 11. |
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| ID | Term |
|---|---|
| D010673 | Pheochromocytoma |
| ID | Term |
|---|---|
| D010235 | Paraganglioma |
| D018358 | Neuroendocrine Tumors |
| D017599 | Neuroectodermal Tumors |
| D009373 | Neoplasms, Germ Cell and Embryonal |
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whole blood, serum
| 7 timepoints during anesthesia (Administration of rocuronium, intubation, cut, intraabdominal air insufflation, ligature of v. suprarenalis, tumor exstirpation, end of operation) |
| Changes in serum concentration: Dopamin | 7 timepoints during anesthesia (Administration of rocuronium, intubation, cut, intraabdominal air insufflation, ligature of v. suprarenalis, tumor exstirpation, end of operation) |
| Changes in plasma concentration: Metanephrines | 7 timepoints during anesthesia (Administration of rocuronium, intubation, cut, intraabdominal air insufflation, ligature of v. suprarenalis, tumor exstirpation, end of operation) |
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
| D009380 | Neoplasms, Nerve Tissue |