How do I install the Ata Ppgl Surgical Approach Selection skill?

Run npx skillmds@latest add dromlakhani/ata-ppgl-surgical-approach-selection in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

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Which AI agents work with Ata Ppgl Surgical Approach Selection?

This skill is tagged as working with Claude Code, Claude.ai, OpenAI Codex. SKILL.md is an open format, so most agents that read a skills directory can load it too.

Is Ata Ppgl Surgical Approach Selection free to use?

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Who published Ata Ppgl Surgical Approach Selection?

dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Ata Ppgl Surgical Approach Selection by dromlakhani

Name: Ata Ppgl Surgical Approach Selection
Rating: 4.5 (4 reviews)
Author: dromlakhani

Ata Ppgl Surgical Approach Selection

Selects surgical approach for pheochromocytoma and paraganglioma resection based on tumor size, invasion suspicion, metastatic status, and familial bilateral risk when a clinician asks 'What surgical approach should I use for this pheochromocytoma patient?' Triggers include confirmed PPGL requiring surgical intervention.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Select surgical approach for pheochromocytoma and paraganglioma resection

STEP 1 — Gather Information

Collect tumor size (cm) via CT/MRI, assess for local invasion (vascular/organ adhesion), perform metastatic workup (imaging for distant metastases), evaluate genetic/family history (bilateral risk), determine laterality (unilateral/bilateral), and ensure preoperative α-blockade adequacy.

STEP 2 — Rule In / Rule Out

Is tumor ≤6 cm with no radiographic evidence of invasion? If yes, proceed to laparoscopic or robot-assisted adrenalectomy; if no, proceed to open adrenalectomy.

STEP 3 — Classify or Stratify

For laparoscopic/robot-assisted pathway: Is there a familial syndrome (e.g., VHL, RET, NF1) with high bilateral risk and tumor ≤5 cm? If yes, consider partial (cortical-sparing) adrenalectomy; if no, proceed with total laparoscopic adrenalectomy. For open surgery pathway: Is metastatic disease present? If yes, consider primary tumor resection (debulking) even in metastatic PPGL; if no, proceed with open adrenalectomy for curative intent.

STEP 4 — Decide

Choose laparoscopic/robot-assisted total adrenalectomy for small non-invasive sporadic tumors; laparoscopic/robot-assisted partial adrenalectomy for small tumors in familial bilateral risk; open total adrenalectomy for large/invasive tumors; open adrenalectomy with debulking intent for metastatic disease.

Clinical Guardrails / Mimics / Pitfalls

Do not proceed to surgery without adequate α-blockade; avoid laparoscopic approach for tumors >6 cm or suspected invasion; do not perform partial adrenalectomy without genetic counseling and surgical expertise; do not omit primary tumor resection in metastatic PPGL; avoid delaying surgery for metastatic workup beyond necessary.

Concrete Clinical Example

A 45-year-old patient with VHL mutation presents with a 3 cm left adrenal tumor, no invasion on imaging, no metastases, and high bilateral risk. Genetic testing confirms VHL. Laparoscopic partial (cortical-sparing) adrenalectomy is selected to preserve adrenal cortex function.

Source: Japan Endocrine Society Clinical Practice Guideline for the Diagnosis and Management of Pheochromocytoma and Paraganglioma 2025, Japan Endocrine Society, 2025, doi:10.1507/endocrj.EJ25-0165

---name: ata-ppgl-surgical-approach-selectiondescription: Selects surgical approach for pheochromocytoma and paraganglioma resection based on tumor size, invasion suspicion, metastatic status, and familial bilateral risk when a clinician asks 'What surgical approach should I use for this pheochromocytoma patient?' Triggers include confirmed PPGL requiring surgical intervention.---# Select surgical approach for pheochromocytoma and paraganglioma resection## STEP 1 — Gather InformationCollect tumor size (cm) via CT/MRI, assess for local invasion (vascular/organ adhesion), perform metastatic workup (imaging for distant metastases), evaluate genetic/family history (bilateral risk), determine laterality (unilateral/bilateral), and ensure preoperative α-blockade adequacy.## STEP 2 — Rule In / Rule OutIs tumor ≤6 cm with no radiographic evidence of invasion? If yes, proceed to laparoscopic or robot-assisted adrenalectomy; if no, proceed to open adrenalectomy.## STEP 3 — Classify or StratifyFor laparoscopic/robot-assisted pathway: Is there a familial syndrome (e.g., VHL, RET, NF1) with high bilateral risk and tumor ≤5 cm? If yes, consider partial (cortical-sparing) adrenalectomy; if no, proceed with total laparoscopic adrenalectomy. For open surgery pathway: Is metastatic disease present? If yes, consider primary tumor resection (debulking) even in metastatic PPGL; if no, proceed with open adrenalectomy for curative intent.## STEP 4 — DecideChoose laparoscopic/robot-assisted total adrenalectomy for small non-invasive sporadic tumors; laparoscopic/robot-assisted partial adrenalectomy for small tumors in familial bilateral risk; open total adrenalectomy for large/invasive tumors; open adrenalectomy with debulking intent for metastatic disease.## Clinical Guardrails / Mimics / PitfallsDo not proceed to surgery without adequate α-blockade; avoid laparoscopic approach for tumors >6 cm or suspected invasion; do not perform partial adrenalectomy without genetic counseling and surgical expertise; do not omit primary tumor resection in metastatic PPGL; avoid delaying surgery for metastatic workup beyond necessary.## Concrete Clinical ExampleA 45-year-old patient with VHL mutation presents with a 3 cm left adrenal tumor, no invasion on imaging, no metastases, and high bilateral risk. Genetic testing confirms VHL. Laparoscopic partial (cortical-sparing) adrenalectomy is selected to preserve adrenal cortex function.**Source:** Japan Endocrine Society Clinical Practice Guideline for the Diagnosis and Management of Pheochromocytoma and Paraganglioma 2025, Japan Endocrine Society, 2025, doi:10.1507/endocrj.EJ25-0165

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