Abstract
An 83-year-old woman underwent partial hepatectomy for a liver metastasis located in segment 7. Preoperative CT showed no neoplastic lesion in the adrenal gland. During mobilization of the right lobe of the liver, accidental laceration of the right adrenal gland occurred, with moderate bleeding. When we applied a mono-polar soft coagulation device to the bleeding surface of the adrenal gland for hemostasis, the systolic blood pressure suddenly shot up to over 200 mmHg. We immediately stopped the coagulation, and intravenous nicardipine was administered promptly by the anesthetist. Soon after, the patient's blood pressure recovered to the normal range and the operation could be completed without any further problems. The postoperative course was uneventful and the patient was discharged on POD14. Because it has been reported that the thermal coagulation effect of mono-polar soft coagulation can reach unpredictably deep levels as compared to that in conventional electrocautery, we speculated that the hypertension was a result of the abrupt catecholamine release induced by thermal stimulation of the adrenal medulla. Surgeons should be aware of the dangers of using a mono-polar soft coagulation device, especially in the vicinity of the adrenal glands.
