WebSurg中文版尚未完成，翻譯工作進行中！

Laparoscopic adrenalectomy for a bilateral large (10 cm) pheochromocytoma

This is a laparoscopic bilateral adrenalectomy performed for bilateral pheochromocytoma. Although the right gland was 10 cm in size, Prof. Targarona demonstrates skillfully how such a resection can be successfully performed laparoscopically if approached in a stepwise and meticulous fashion. This video is suitable for advanced laparoscopic surgeons. Once the author identifies the inferior vena cava, he carefully carries out the dissection along its right border to expose the right adrenal vein. He then retracts the adrenal gland in an atraumatic fashion with a peanut gauze, being careful not to rupture the gland. Using gentle retraction with right-angle forceps, the author isolates the right adrenal vein. It is double-clipped then divided. This enables mobilization of the gland. The author then uses the harmonic scalpel to dissect around the gland. The tool can also be used to clip or divide the pedicles often encountered in this step. Once the gland is completely mobilized, one must still handle it with care. The author placed it in an extraction bag.

建立帳號

瀏覽全世界

繁體中文 ▼

Google translate

總結
章節
您的意見
詢問專家群

欲觀看此影片請先登入！

Laparoscopic adrenalectomy for a bilateral large (10 cm) pheochromocytoma

作者群

摘要

This is a laparoscopic bilateral adrenalectomy performed for bilateral pheochromocytoma. Although the right gland was 10 cm in size, Prof. Targarona demonstrates skillfully how such a resection can be successfully performed laparoscopically if approached in a stepwise and meticulous fashion. This video is suitable for advanced laparoscopic surgeons.

Once the author identifies the inferior vena cava, he carefully carries out the dissection along its right border to expose the right adrenal vein. He then retracts the adrenal gland in an atraumatic fashion with a peanut gauze, being careful not to rupture the gland. Using gentle retraction with right-angle forceps, the author isolates the right adrenal vein. It is double-clipped then divided. This enables mobilization of the gland. The author then uses the harmonic scalpel to dissect around the gland. The tool can also be used to clip or divide the pedicles often encountered in this step. Once the gland is completely mobilized, one must still handle it with care. The author placed it in an extraction bag.

關鍵字

laparoscopy, adrenal gland, pheochromocytoma, bilateral, resection

媒體類型

手術影片

期間

09'00''

刊物

2007-05

普通的

最愛

Favorites Media

音訊

副標題

數位出版

WeBSurg.com, May 2007;7(05).
URL: http://www.websurg.com/doi-vd01en2136.htm

Laparoscopic adrenalectomy for a bilateral large (10 cm) pheochromocytoma

1. Left adrenalectomy 00'15''

This video demonstrates the procedure of laparoscopic transabdominal bilateral adrenalectomy performed for bilateral pheochromocytoma.The patient is a 50-year-old man and as you observe the CT-scan showed bilaterally enlarged adrenal glands, with the right gland markedly bigger than the left, measuring 10cm in mean diameter. The patient is placed first in a full right lateral position as the left gland is removed first. 4 trocars are placed along the left costal margin. The first step is to approach the left adrenal widely mobilising the spleen and the tail of the pancreas. The plane behind these 2 organs is avascular and the dissection is advanced gently, allowing the spleen and the tail of the pancreas to fall anteriorly. The dissection is completed when the splenic vein is well visualised. The dissection then proceeds downwards in order to identify the left renal vein. This is an important landmark as the left adrenal vein is a tributary of the renal vein. Therefore, once the renal vein is identified, its upper surface is dissected carefully to identify the adrenal vein.

2. Division of left adrenal vein 02'26''

After the adrenal vein is isolated it is then doubly clipped before division. Once this important step is completed, the adrenal gland can be held upwards in an atraumatic fashion, and the retroglandular space dissected. This implies dissecting through the yellow fatty tissue until the red coloured retroperitoneal muscle layer is visible. A number of small vessels that irrigate the gland are encountered during this dissection and it is possible to divide them with the ultrasonic scalpel as shown. Sometimes larger vessels are encountered and it may be necessary to place clips for added security.

3. Right adrenalectomy 04'00''

Once the gland is completely free, the adrenal bed is irrigated and the gland removed in an extraction bag. Now the left adrenalectomy is complete and the trocars are removed. The anatomical approach to the right adrenal gland is somewhat different from the left because of the different organs encountered on this side. The right lobe of the liver is retracted cranially with a liver retractor. In this case, the adrenal gland is so large that the inferior vena cava has to be approached from below the gland. Therefore the retroperitoneum is opened and the duodenum is first Kocherised widely, that is, it is mobilised and rotated anteriorly and to the left. This manoeuvre is carefully done, and once it is complete, it exposes the IVC, the important landmark for identification of the right adrenal vein.

4. Division of right adrenal vein 05'16''

Now that we have identified the IVC,the dissection is continued carefully along its right border in order to expose the right adrenal vein. The bulk of the adrenal gland makes this difficult and it is essential to retract the gland in an atraumatic fashion, in this case using peanut gauze held in graspers. Rupture of the adrenal gland in this situation would lead to haemorrhage, which could make good visualisation impossible, not to mention dissemination of tumour. But as you can observe, with a combination of gentle retraction and careful dissection with a right angle forceps, the short right adrenal vein is isolated, and then doubly clipped, and then finally divided. After this important step, the gland can then be mobilised just as was done on the other side. We use the ultrasonic scalpel to dissect the space around the gland, medially along the IVC, inferiorly through the yellow fat around the superior pole of the kidney, superiorly from the inferior surface of the liver, and posteriorly and laterally from the red-coloured retroperitoneal muscles. A number of pedicles are usually encountered and these can either be clipped or divided directly using the ultrasonic scalpel. In a large gland such as this, the dissection should be meticulous and gentle to avoid complications such as rupture of the gland and haemorrhage.