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Endocrine surgery

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.


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Robotic adrenalectomy for left adrenal Conn’s adenoma: live broadcast
According to recent studies, robotic adrenalectomy has proven to be superior to laparoscopic adrenalectomy, with a reduction of blood loss during procedure and a reduced operative time.
The robotic system provides an intraoperative stability to the surgeon, allowing for a perfect handling of sensitive functional adrenal tumors. The main advantage of robotics lies in the ease of dissection, aided by improved visualization, the EndoWrist®, articulated instruments, and reduction of tremors, allowing for more accurate movements.

Indications: hormone-secreting tumors, adrenal masses >5cm, smaller lesions suspicious for malignancy, and lesions increasing in size on serial imaging.
Contraindications: infiltrative adrenal masses and tumors of extremely large size, because the size of adrenal lesions correlates with the potential for adrenal carcinoma.
The da Vinci Robotic Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) and the following robotic instruments are used:30-degree scope, ProGrasp™ forceps, Hot Shears (monopolar curved scissors or a hook), and a Robotic Clip Applier. A monopolar cautery hook and Harmonic ACE® curved shears can also be used when deemed helpful by the surgeon.
Laparoscopic instruments that can be handled by the bedside assistant, a clip applier and a suction device are also used.
CN Tang
Surgical intervention
2 years ago
1753 views
132 likes
0 comments
24:47
Robotic adrenalectomy for left adrenal Conn’s adenoma: live broadcast
According to recent studies, robotic adrenalectomy has proven to be superior to laparoscopic adrenalectomy, with a reduction of blood loss during procedure and a reduced operative time.
The robotic system provides an intraoperative stability to the surgeon, allowing for a perfect handling of sensitive functional adrenal tumors. The main advantage of robotics lies in the ease of dissection, aided by improved visualization, the EndoWrist®, articulated instruments, and reduction of tremors, allowing for more accurate movements.

Indications: hormone-secreting tumors, adrenal masses >5cm, smaller lesions suspicious for malignancy, and lesions increasing in size on serial imaging.
Contraindications: infiltrative adrenal masses and tumors of extremely large size, because the size of adrenal lesions correlates with the potential for adrenal carcinoma.
The da Vinci Robotic Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) and the following robotic instruments are used:30-degree scope, ProGrasp™ forceps, Hot Shears (monopolar curved scissors or a hook), and a Robotic Clip Applier. A monopolar cautery hook and Harmonic ACE® curved shears can also be used when deemed helpful by the surgeon.
Laparoscopic instruments that can be handled by the bedside assistant, a clip applier and a suction device are also used.
LIVE INTERACTIVE SURGERY: laparoscopic left adrenalectomy for pheochromocytoma
Laparoscopic adrenalectomy was first described by Gagner et al. in 1992. It has become the procedure of choice for most benign adrenal lesions since then because of decreased blood loss, shorter hospital stay, faster recovery, and lower morbidity as compared to open surgery.
The indications for laparoscopic adrenalectomy are the same as for open surgery, except in cases of confirmed adrenocortical carcinomas.
Absolute contraindications for laparoscopic adrenalectomy are as follows: severe cardiopulmonary disease, locally advanced tumors, medically untreated pheochromocytoma, and uncontrolled coagulopathies. This is a live demonstration of a left adrenalectomy recorded during the Minimally Invasive Endocrine Surgery Course, which was held at IRCAD in May 2016.
D Mutter, P Donepudi, J Marescaux
Surgical intervention
2 years ago
3661 views
331 likes
0 comments
28:17
LIVE INTERACTIVE SURGERY: laparoscopic left adrenalectomy for pheochromocytoma
Laparoscopic adrenalectomy was first described by Gagner et al. in 1992. It has become the procedure of choice for most benign adrenal lesions since then because of decreased blood loss, shorter hospital stay, faster recovery, and lower morbidity as compared to open surgery.
The indications for laparoscopic adrenalectomy are the same as for open surgery, except in cases of confirmed adrenocortical carcinomas.
Absolute contraindications for laparoscopic adrenalectomy are as follows: severe cardiopulmonary disease, locally advanced tumors, medically untreated pheochromocytoma, and uncontrolled coagulopathies. This is a live demonstration of a left adrenalectomy recorded during the Minimally Invasive Endocrine Surgery Course, which was held at IRCAD in May 2016.
LIVE INTERACTIVE SURGERY: laparoscopic left adrenalectomy: retroperitoneal access
Retroperitoneal adrenalectomy (posterior approach) provides a direct access to the adrenal gland, hence preventing the risk of injury to intraperitoneal organs. The retroperitoneoscopic approach shortens the mean operative time and it is critical in cases of pheochromocytoma. Consequently, it is the recommended treatment for pheochromocytoma. Blood loss and the convalescence period are also shortened with this approach. The surgical principles of retroperitoneal adrenalectomy according to Professor Martin Walz are as follows: ‘en bloc’ resection, start of dissection with the upper pole of kidney, lower pole of the adrenal gland next, control of the main adrenal vein without clips, and morcellation of the gland if necessary in a bag.
M Walz, P Donepudi, L Soler, B Seeliger
Surgical intervention
2 years ago
1820 views
173 likes
0 comments
39:46
LIVE INTERACTIVE SURGERY: laparoscopic left adrenalectomy: retroperitoneal access
Retroperitoneal adrenalectomy (posterior approach) provides a direct access to the adrenal gland, hence preventing the risk of injury to intraperitoneal organs. The retroperitoneoscopic approach shortens the mean operative time and it is critical in cases of pheochromocytoma. Consequently, it is the recommended treatment for pheochromocytoma. Blood loss and the convalescence period are also shortened with this approach. The surgical principles of retroperitoneal adrenalectomy according to Professor Martin Walz are as follows: ‘en bloc’ resection, start of dissection with the upper pole of kidney, lower pole of the adrenal gland next, control of the main adrenal vein without clips, and morcellation of the gland if necessary in a bag.
Posterior retroperitoneoscopic revision of the right suprarenal space for recurrence of pheochromocytoma
A 36-year-old woman came to the attention of the endocrinologist for a recent onset of headache and tachycardia and an US finding of a 1.8cm nodule in the right suprarenal space.
At age 25, she was submitted to an anterior laparoscopic transperitoneal right adrenalectomy for a 5cm pheochromocytoma. At age 33, she underwent laparoscopic cholecystectomy.
The diagnostic work-up revealed raised urinary metanephrine and normetanephrine and an MRI finding of a 1.5cm nodule in the right suprarenal space, with smaller satellite nodules in the retrocaval space.
A surgical revision of the right suprarenal space was indicated and the posterior retroperitoneal approach was chosen, to warrant better reach of the nodules and allow direct exposure of the retrocaval and retrohepatic spaces.
The operative time was 210 minutes. The patient recovered with no major complications and was discharged on her 4th postoperative day. Her symptoms recovered and she was found with lowered metanephrines at follow-up. An 18-FDG PET-CT scan performed 6 months after the operation showed no abnormal metabolic activity within her body.
M Lotti, M Giulii Capponi, B Carrara, L Moroni, S Cassibba, D Gianola
Surgical intervention
2 years ago
797 views
40 likes
0 comments
16:24
Posterior retroperitoneoscopic revision of the right suprarenal space for recurrence of pheochromocytoma
A 36-year-old woman came to the attention of the endocrinologist for a recent onset of headache and tachycardia and an US finding of a 1.8cm nodule in the right suprarenal space.
At age 25, she was submitted to an anterior laparoscopic transperitoneal right adrenalectomy for a 5cm pheochromocytoma. At age 33, she underwent laparoscopic cholecystectomy.
The diagnostic work-up revealed raised urinary metanephrine and normetanephrine and an MRI finding of a 1.5cm nodule in the right suprarenal space, with smaller satellite nodules in the retrocaval space.
A surgical revision of the right suprarenal space was indicated and the posterior retroperitoneal approach was chosen, to warrant better reach of the nodules and allow direct exposure of the retrocaval and retrohepatic spaces.
The operative time was 210 minutes. The patient recovered with no major complications and was discharged on her 4th postoperative day. Her symptoms recovered and she was found with lowered metanephrines at follow-up. An 18-FDG PET-CT scan performed 6 months after the operation showed no abnormal metabolic activity within her body.
Cystic pheochromocytoma: anatomical landmarks for laparoscopic resection
Surgery for pheochromocytoma is often considered difficult due to local anatomical conditions which are often associated with a hypervascularization and inflammatory reaction. This video demonstrates the case of a patient presenting with a 5cm pheochromocytoma with a necrotic core. Because the patient has a low BMI, the intraoperative anatomy is magnified and all anatomical landmarks are perfectly identified right before dissection. The lesion is eventually embedded in the liver. Its approach and dissection allow to determine the constraints related to adrenal surgery, and particularly regarding the impossibility to manipulate the lesion other than with soft retraction.
D Mutter, J Marescaux
Surgical intervention
3 years ago
2071 views
104 likes
0 comments
15:04
Cystic pheochromocytoma: anatomical landmarks for laparoscopic resection
Surgery for pheochromocytoma is often considered difficult due to local anatomical conditions which are often associated with a hypervascularization and inflammatory reaction. This video demonstrates the case of a patient presenting with a 5cm pheochromocytoma with a necrotic core. Because the patient has a low BMI, the intraoperative anatomy is magnified and all anatomical landmarks are perfectly identified right before dissection. The lesion is eventually embedded in the liver. Its approach and dissection allow to determine the constraints related to adrenal surgery, and particularly regarding the impossibility to manipulate the lesion other than with soft retraction.
Robotic left adrenalectomy for Conn's syndrome
Introduction: Since the first robotic adrenalectomy by Piazza et al. in 1999, using both the ZEUS and AESOP systems, numerous series and case reports have been published describing both left and right adrenalectomies using both transperitoneal and retroperitoneal approaches. These studies demonstrate that the robotic approach is feasible and safe.
Methods: This is the case of a 43-year-old female patient who presented with weakness, muscular cramps and systemic arterial hypertension. Her blood tests revealed a high Na++, low K+, very low renin (inhibited) and high aldosterone dose levels. A CT-scan showed a unique adenoma within 2.6cm at the left adrenal gland. She was diagnosed with Conn’s syndrome.
Results: In this video showing a robotic left adrenalectomy, the patient was placed in a left lateral decubitus, jack-knife position. Four robotic arms were used. Dissection was performed by means of scissors and of a bipolar fenestrated forceps. Operative time took 95 minutes. No measurable bleeding was observed. No UCI stay was necessary and the patient was discharged 24 hours after the intervention.
Conclusion: In this case, adrenal surgery was performed using a robotic approach, which demonstrated that the procedure was feasible, safe, with a low morbidity and a short hospital stay.
Fe Madureira, Fa Madureira, E Parra-Davila, D Madureira
Surgical intervention
4 years ago
1633 views
63 likes
0 comments
08:20
Robotic left adrenalectomy for Conn's syndrome
Introduction: Since the first robotic adrenalectomy by Piazza et al. in 1999, using both the ZEUS and AESOP systems, numerous series and case reports have been published describing both left and right adrenalectomies using both transperitoneal and retroperitoneal approaches. These studies demonstrate that the robotic approach is feasible and safe.
Methods: This is the case of a 43-year-old female patient who presented with weakness, muscular cramps and systemic arterial hypertension. Her blood tests revealed a high Na++, low K+, very low renin (inhibited) and high aldosterone dose levels. A CT-scan showed a unique adenoma within 2.6cm at the left adrenal gland. She was diagnosed with Conn’s syndrome.
Results: In this video showing a robotic left adrenalectomy, the patient was placed in a left lateral decubitus, jack-knife position. Four robotic arms were used. Dissection was performed by means of scissors and of a bipolar fenestrated forceps. Operative time took 95 minutes. No measurable bleeding was observed. No UCI stay was necessary and the patient was discharged 24 hours after the intervention.
Conclusion: In this case, adrenal surgery was performed using a robotic approach, which demonstrated that the procedure was feasible, safe, with a low morbidity and a short hospital stay.
Laparoscopic resection of extra-adrenal paraganglioma
Introduction
Paragangliomas are rare tumors that arise from extra-adrenal chromaffin cells. These tumors arise from dispersed paraganglia that tend to be symmetrically distributed in close relation to the aorta and to the sympathetic nervous system. Paragangliomas have a higher malignancy potential than adrenal pheochromocytomas.
Laparoscopy has the advantage of optical magnification and provides better visualization of small vessels, which allows for meticulous dissection during tumor excision. Laparoscopic resections of such tumors have been described in isolated cases.

Material and methods
We present the case of a 16-year-old female patient who presents with repeated urinary tract infection. An ultrasound demonstrates the presence of a retropancreatic mass. The study was completed by abdominal CT-scan and PET-scan (123-MIBG) where a solid mass of 4.5cm in diameter, homogeneous, encapsulated, without calcifications, located between the third duodenal portion (which is displaced anteriorly) and the inferior vena cava from the level of the right renal vein to the level of the right renal lower pole, is found. The patient presents MIBG (metaiodobenzylguanidine) tracer uptake in the Iodine-123-MIBG scintigraphy, suggesting the diagnosis of adrenal medullary tumor. The hormonal study shows a significant increase in plasmatic normetanephrine (25 times the normal upper limit). A genetic study has found no mutation of the most frequent responsible genes.
Given radiological and hormonal findings, laparoscopic surgery is decided upon with suspected diagnosis of extra-adrenal paraganglioma.

Discussion
In this video, we present a laparoscopic approach to this mass, using an 11mm optical trocar and four 5mm working trocars. As can be appreciated, a very careful dissection is carried out to separate the mass from adjacent structures, dissecting small vessels that drain directly into the inferior vena cava.
Final pathology reports a 5cm retroperitoneal paraganglioma, with vascular invasion. In the immunohistochemical study, cells are positive for Synaptophysin and Chromogranin A. The postoperative course was uneventful, and the patient was discharged on postoperative day 4.
The laparoscopic excision of paraganglioma is safe and feasible, reduces postoperative pain, facilitates early recovery, and shortens hospital stay as compared to open surgery.
As a general conclusion, it is essential to diagnose, localize, and treat paragangliomas, because of the potential cure of symptoms associated with functional tumors, prevention of a lethal hypertensive paroxysm, and early diagnosis of malignant tumors.
Laparoscopy has the advantage of optical magnification and provides better visualization of small vessels, which allows for meticulous dissection during tumor excision. Tumors located between major vessels rarely invade these vessels, but careful and meticulous dissection of the surrounding small vessels is necessary.
The laparoscopic excision of paraganglioma reduces postoperative pain, facilitates early recovery, and shortens hospital stay as compared to open surgery.
C Rodríguez-Otero Luppi, M Rodríguez Blanco, V Artigas Raventós, M Trías Folch
Surgical intervention
4 years ago
988 views
34 likes
0 comments
12:04
Laparoscopic resection of extra-adrenal paraganglioma
Introduction
Paragangliomas are rare tumors that arise from extra-adrenal chromaffin cells. These tumors arise from dispersed paraganglia that tend to be symmetrically distributed in close relation to the aorta and to the sympathetic nervous system. Paragangliomas have a higher malignancy potential than adrenal pheochromocytomas.
Laparoscopy has the advantage of optical magnification and provides better visualization of small vessels, which allows for meticulous dissection during tumor excision. Laparoscopic resections of such tumors have been described in isolated cases.

Material and methods
We present the case of a 16-year-old female patient who presents with repeated urinary tract infection. An ultrasound demonstrates the presence of a retropancreatic mass. The study was completed by abdominal CT-scan and PET-scan (123-MIBG) where a solid mass of 4.5cm in diameter, homogeneous, encapsulated, without calcifications, located between the third duodenal portion (which is displaced anteriorly) and the inferior vena cava from the level of the right renal vein to the level of the right renal lower pole, is found. The patient presents MIBG (metaiodobenzylguanidine) tracer uptake in the Iodine-123-MIBG scintigraphy, suggesting the diagnosis of adrenal medullary tumor. The hormonal study shows a significant increase in plasmatic normetanephrine (25 times the normal upper limit). A genetic study has found no mutation of the most frequent responsible genes.
Given radiological and hormonal findings, laparoscopic surgery is decided upon with suspected diagnosis of extra-adrenal paraganglioma.

Discussion
In this video, we present a laparoscopic approach to this mass, using an 11mm optical trocar and four 5mm working trocars. As can be appreciated, a very careful dissection is carried out to separate the mass from adjacent structures, dissecting small vessels that drain directly into the inferior vena cava.
Final pathology reports a 5cm retroperitoneal paraganglioma, with vascular invasion. In the immunohistochemical study, cells are positive for Synaptophysin and Chromogranin A. The postoperative course was uneventful, and the patient was discharged on postoperative day 4.
The laparoscopic excision of paraganglioma is safe and feasible, reduces postoperative pain, facilitates early recovery, and shortens hospital stay as compared to open surgery.
As a general conclusion, it is essential to diagnose, localize, and treat paragangliomas, because of the potential cure of symptoms associated with functional tumors, prevention of a lethal hypertensive paroxysm, and early diagnosis of malignant tumors.
Laparoscopy has the advantage of optical magnification and provides better visualization of small vessels, which allows for meticulous dissection during tumor excision. Tumors located between major vessels rarely invade these vessels, but careful and meticulous dissection of the surrounding small vessels is necessary.
The laparoscopic excision of paraganglioma reduces postoperative pain, facilitates early recovery, and shortens hospital stay as compared to open surgery.
Transumbilical single access laparoscopic right adrenalectomy with 1.8mm epigastric trocarless grasping forceps
Background: Single access laparoscopic adrenalectomy has been reported in supine and prone patient positioning. The authors report the technique with the patient in supine position, with the umbilicus as access site, and with all adopted material as reusable.

Video: A 43-year-old woman was admitted to the hospital for symptomatic primary hyperaldosteronism. A right-side adrenal adenoma was diagnosed, and surgery was proposed. The patient was placed in a supine position with a mild semi-lateral left-sided decubitus. The technique was performed using an 11mm reusable trocar to accommodate a 10mm, 30-degree rigid and regular length scope, in addition to curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany). The right liver lobe was retracted using the 1.8mm trocarless grasping forceps according to DAPRI (Karl Storz Endoskope), inserted percutaneously under the 12th right rib. The procedure started with the adhesiolysis between the hepatic surface and right Gerota’s fascia. Then, after having identified the adrenal gland, it was dissected and the inferior adrenal arteries and veins were clipped between 5mm Hem-o-lok® clips (Teleflex Medical, Research Triangle Park, NC, US). The middle adrenal vein was clipped as well using the 5mm Hem-o-lok® ligation systems. Once the specimen was completely mobilized, a plastic bag (used for suction drain) was custom-made and introduced into the abdomen through the 11mm trocar. The specimen was removed transumbilically, and the procedure finished with the closure of the access site by absorbable figure of 8 sutures.

Results: Laparoscopic time was 98 minutes, estimated blood loss was 20cc, and the final scar length was 16mm. The patient was discharged from the hospital after 2 days.

Conclusions: Transumbilical single access laparoscopic right adrenalectomy is feasible and safe. With this technique, the cost of the procedure is not increased, the final scar length is minimal, and the working triangulation is established intrabdominally as well as externally.
G Dapri, L Gerard, M Bortes, V Zulian, GB Cadière
Surgical intervention
5 years ago
1825 views
25 likes
0 comments
06:24
Transumbilical single access laparoscopic right adrenalectomy with 1.8mm epigastric trocarless grasping forceps
Background: Single access laparoscopic adrenalectomy has been reported in supine and prone patient positioning. The authors report the technique with the patient in supine position, with the umbilicus as access site, and with all adopted material as reusable.

Video: A 43-year-old woman was admitted to the hospital for symptomatic primary hyperaldosteronism. A right-side adrenal adenoma was diagnosed, and surgery was proposed. The patient was placed in a supine position with a mild semi-lateral left-sided decubitus. The technique was performed using an 11mm reusable trocar to accommodate a 10mm, 30-degree rigid and regular length scope, in addition to curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany). The right liver lobe was retracted using the 1.8mm trocarless grasping forceps according to DAPRI (Karl Storz Endoskope), inserted percutaneously under the 12th right rib. The procedure started with the adhesiolysis between the hepatic surface and right Gerota’s fascia. Then, after having identified the adrenal gland, it was dissected and the inferior adrenal arteries and veins were clipped between 5mm Hem-o-lok® clips (Teleflex Medical, Research Triangle Park, NC, US). The middle adrenal vein was clipped as well using the 5mm Hem-o-lok® ligation systems. Once the specimen was completely mobilized, a plastic bag (used for suction drain) was custom-made and introduced into the abdomen through the 11mm trocar. The specimen was removed transumbilically, and the procedure finished with the closure of the access site by absorbable figure of 8 sutures.

Results: Laparoscopic time was 98 minutes, estimated blood loss was 20cc, and the final scar length was 16mm. The patient was discharged from the hospital after 2 days.

Conclusions: Transumbilical single access laparoscopic right adrenalectomy is feasible and safe. With this technique, the cost of the procedure is not increased, the final scar length is minimal, and the working triangulation is established intrabdominally as well as externally.
Laparoscopic left adrenalectomy for incidentally detected large adrenal mass
We report the typical case of a young woman presenting with an incidentally detected large left adrenal mass. This was a non-functional tumor incidentally detected during ultrasound scan for other reason. CT-scan confirmed a large adrenal mass with diffuse contrast-enhancement. Blood tests for adrenal function were negative.
A laparoscopic left adrenalectomy was proposed with the main objective to perform a complete left adrenalectomy since the malignant nature of the mass cannot be excluded by available imaging studies. For laparoscopic left adrenalectomy, the patient is in a typical right lateral position. The optical trocar is in the left subcostal position. A 10mm trocar is introduced into the anterior axillary line while other 5 or 10mm trocars are placed laterally under the costal margin.
For the surgical resection of this large tumor, dissection started with the opening of the retroperitoneal space, and with the mobilization of the spleen and tail of pancreas. The renal vein is the secondary key point of dissection, allowing to identify the main adrenal vein. At this point, dissection is continued on the right side of the gland in order to identify the left adrenal artery, up to the inferior phrenic vein, and to the superior adrenal artery. The mass is cleared and removed through the extraction bag.
Editorial note: Luigi Mearini et al. have reported a left adrenalectomy exactly reproducing anatomical and technical principles as detailed on WebSurg.com. This confirms that the technique can be reproduced easily.
L Mearini, E Nunzi
Surgical intervention
5 years ago
4663 views
114 likes
0 comments
13:26
Laparoscopic left adrenalectomy for incidentally detected large adrenal mass
We report the typical case of a young woman presenting with an incidentally detected large left adrenal mass. This was a non-functional tumor incidentally detected during ultrasound scan for other reason. CT-scan confirmed a large adrenal mass with diffuse contrast-enhancement. Blood tests for adrenal function were negative.
A laparoscopic left adrenalectomy was proposed with the main objective to perform a complete left adrenalectomy since the malignant nature of the mass cannot be excluded by available imaging studies. For laparoscopic left adrenalectomy, the patient is in a typical right lateral position. The optical trocar is in the left subcostal position. A 10mm trocar is introduced into the anterior axillary line while other 5 or 10mm trocars are placed laterally under the costal margin.
For the surgical resection of this large tumor, dissection started with the opening of the retroperitoneal space, and with the mobilization of the spleen and tail of pancreas. The renal vein is the secondary key point of dissection, allowing to identify the main adrenal vein. At this point, dissection is continued on the right side of the gland in order to identify the left adrenal artery, up to the inferior phrenic vein, and to the superior adrenal artery. The mass is cleared and removed through the extraction bag.
Editorial note: Luigi Mearini et al. have reported a left adrenalectomy exactly reproducing anatomical and technical principles as detailed on WebSurg.com. This confirms that the technique can be reproduced easily.
Transumbilical single access laparoscopic left adrenalectomy for symptomatic pheochromocytoma
Background: Single access laparoscopy has been reported for adrenal gland surgery. This technique can also be applied for patients presenting non-small lesions and symptomatic diseases such as pheochromocytoma.

Video: A 17-year-old woman was admitted to hospital for severe headaches, palpitations, and tachycardia along with tremulousness, dizziness, and vomiting. A symptomatic left-side single location adrenal pheochromocytoma was diagnosed and a transumbilical single access laparoscopic left adrenalectomy was proposed. The patient was placed in a semi-lateral right-sided decubitus. The technique was performed using an 11mm reusable trocar to accommodate a 10mm, 30-degree rigid and regular length scope in addition to curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tüttlingen, Germany). The procedure started with the opening of the splenocolic ligament and, after mobilization of the splenopancreatic block medially, the adrenal lesion was demonstrated. Probably due to the size of the lesion, only two main adrenal vessels were found: vein and mid-artery. Both vessels were dissected and divided between 5mm non-absorbable clips. The specimen was retrieved transumbilically in a custom-made plastic bag.

Results: Laparoscopic time was 129 minutes, estimated blood loss 20cc, and the final scar length measured 16mm. The symptomatic status of the patient was resolved immediately. The patient was discharged from the intensive care unit after 3 days and from the hospital after 6 days.

Conclusions: Transumbilical single access laparoscopic left adrenalectomy for symptomatic pheochromocytoma is feasible and safe. In young ladies, it offers an excellent cosmetic result, avoiding abdominal trauma.
G Dapri, V Zulian, M Bortes, P Mathonet, GB Cadière
Surgical intervention
5 years ago
1473 views
14 likes
0 comments
07:29
Transumbilical single access laparoscopic left adrenalectomy for symptomatic pheochromocytoma
Background: Single access laparoscopy has been reported for adrenal gland surgery. This technique can also be applied for patients presenting non-small lesions and symptomatic diseases such as pheochromocytoma.

Video: A 17-year-old woman was admitted to hospital for severe headaches, palpitations, and tachycardia along with tremulousness, dizziness, and vomiting. A symptomatic left-side single location adrenal pheochromocytoma was diagnosed and a transumbilical single access laparoscopic left adrenalectomy was proposed. The patient was placed in a semi-lateral right-sided decubitus. The technique was performed using an 11mm reusable trocar to accommodate a 10mm, 30-degree rigid and regular length scope in addition to curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tüttlingen, Germany). The procedure started with the opening of the splenocolic ligament and, after mobilization of the splenopancreatic block medially, the adrenal lesion was demonstrated. Probably due to the size of the lesion, only two main adrenal vessels were found: vein and mid-artery. Both vessels were dissected and divided between 5mm non-absorbable clips. The specimen was retrieved transumbilically in a custom-made plastic bag.

Results: Laparoscopic time was 129 minutes, estimated blood loss 20cc, and the final scar length measured 16mm. The symptomatic status of the patient was resolved immediately. The patient was discharged from the intensive care unit after 3 days and from the hospital after 6 days.

Conclusions: Transumbilical single access laparoscopic left adrenalectomy for symptomatic pheochromocytoma is feasible and safe. In young ladies, it offers an excellent cosmetic result, avoiding abdominal trauma.
Typical laparoscopic four-trocar transabdominal adrenalectomy for a 5cm right-sided pheochromocytoma
This is the case of a female patient presenting with a typical 5cm right-sided pheochromocytoma was operated on laparoscopically. Preoperative 3D MRI reconstruction allowed to precisely identify surgical landmarks. The procedure was carried out typically. Four ports were used, and dissection aimed to first mobilize the liver. Control of the main adrenal vein was achieved as the first operative step. Medial, superior, and inferior arteries were dissected and controlled successively. Total freeing of the gland was performed with no manipulation or effraction of the gland's capsule. The postoperative course was uneventful. Small-sized pheochromocytomas are excellent indications for a laparoscopic approach with early control of the vein.
D Mutter, M Vix, L Soler, J Marescaux
Surgical intervention
5 years ago
3200 views
77 likes
0 comments
23:50
Typical laparoscopic four-trocar transabdominal adrenalectomy for a 5cm right-sided pheochromocytoma
This is the case of a female patient presenting with a typical 5cm right-sided pheochromocytoma was operated on laparoscopically. Preoperative 3D MRI reconstruction allowed to precisely identify surgical landmarks. The procedure was carried out typically. Four ports were used, and dissection aimed to first mobilize the liver. Control of the main adrenal vein was achieved as the first operative step. Medial, superior, and inferior arteries were dissected and controlled successively. Total freeing of the gland was performed with no manipulation or effraction of the gland's capsule. The postoperative course was uneventful. Small-sized pheochromocytomas are excellent indications for a laparoscopic approach with early control of the vein.
Robot-assisted left adrenalectomy for Conn's adenoma
As laparoscopy is the standard approach to perform an adrenalectomy, robotic assistance is considered as an effective tool to perform this resection. Surgical steps follow those established for laparoscopy (i.e., mobilization of the spleen and of the pancreas in a patient placed in a lateral position, identification of the renal vein, control and division of the adrenal vein, successive freeing of the medial, external, inferior, and finally posterior aspects of the gland. The sealing devices such as ultrasonic dissectors are well adapted to perform this resection, and to safely control adrenal arteries. Robotic assistance takes full benefit from the degrees of freedom of the tips of the instruments and allows for an easy adrenal gland mobilization and removal.
D Mutter, L Soler, J Marescaux
Surgical intervention
6 years ago
1661 views
23 likes
0 comments
16:19
Robot-assisted left adrenalectomy for Conn's adenoma
As laparoscopy is the standard approach to perform an adrenalectomy, robotic assistance is considered as an effective tool to perform this resection. Surgical steps follow those established for laparoscopy (i.e., mobilization of the spleen and of the pancreas in a patient placed in a lateral position, identification of the renal vein, control and division of the adrenal vein, successive freeing of the medial, external, inferior, and finally posterior aspects of the gland. The sealing devices such as ultrasonic dissectors are well adapted to perform this resection, and to safely control adrenal arteries. Robotic assistance takes full benefit from the degrees of freedom of the tips of the instruments and allows for an easy adrenal gland mobilization and removal.
Posterior approach to laparoscopic left adrenalectomy including virtual reality simulation
Since M. Gagner published the first case of a transperitoneal laparoscopic adrenalectomy in 1992, the laparoscopic adrenalectomy has gradually become the standard operation for removing adrenal tumors. Compared to a traditional adrenalectomy, a laparoscopic adrenalectomy has a number of advantages, including less blood loss, a shorter hospital stay, a quicker recovery, and fewer complications. There are many ways to approach the adrenal gland laparoscopically, such as by a lateral transperitoneal approach, anterior transperitoneal approach, lateral retroperitoneal approach, and posterior retroperitoneal approach. This video shows a posterior left adrenalectomy using virtual reality simulation.
M Walz, L Soler, J Marescaux
Surgical intervention
7 years ago
1872 views
30 likes
1 comment
25:24
Posterior approach to laparoscopic left adrenalectomy including virtual reality simulation
Since M. Gagner published the first case of a transperitoneal laparoscopic adrenalectomy in 1992, the laparoscopic adrenalectomy has gradually become the standard operation for removing adrenal tumors. Compared to a traditional adrenalectomy, a laparoscopic adrenalectomy has a number of advantages, including less blood loss, a shorter hospital stay, a quicker recovery, and fewer complications. There are many ways to approach the adrenal gland laparoscopically, such as by a lateral transperitoneal approach, anterior transperitoneal approach, lateral retroperitoneal approach, and posterior retroperitoneal approach. This video shows a posterior left adrenalectomy using virtual reality simulation.
Prevesical genetic paraganglioma and left adrenal mass: laparoscopic resection
Hereditary paraganglioma-pheochromocytoma syndromes are caused by genetic mutations, which lead to the development of multiple neuroendocrine tumors and paraganglioma tumors in the adrenal glands. We report the case of a young patient aged 13 who has been followed up routinely for a familial mutation of the SDHB gene. In this routine follow-up examination, an excessive plasma normetanephrine and norepinephrine secretion is evidenced. A genetic paraganglioma is diagnosed. Imaging studies are conducted to identify its location. A prevesical fixation is demonstrated by both the PET-scan and the MIBG scintigraphy. In this video, a laparoscopic resection of both lesions is demonstrated.
D Mutter, J Marescaux
Surgical intervention
8 years ago
1037 views
7 likes
0 comments
09:10
Prevesical genetic paraganglioma and left adrenal mass: laparoscopic resection
Hereditary paraganglioma-pheochromocytoma syndromes are caused by genetic mutations, which lead to the development of multiple neuroendocrine tumors and paraganglioma tumors in the adrenal glands. We report the case of a young patient aged 13 who has been followed up routinely for a familial mutation of the SDHB gene. In this routine follow-up examination, an excessive plasma normetanephrine and norepinephrine secretion is evidenced. A genetic paraganglioma is diagnosed. Imaging studies are conducted to identify its location. A prevesical fixation is demonstrated by both the PET-scan and the MIBG scintigraphy. In this video, a laparoscopic resection of both lesions is demonstrated.
Laparoscopic left adrenalectomy for Conn's adenoma: three trocar technique
Conn's disease is a condition in which the adrenal glands produce too much aldosterone. Prevalence estimates for Conn's syndrome is about 0.03-1.2% of the population with hypertension.
Many patients with Conn's disease have a high blood pressure that is difficult to control. This increases the risk of stroke, heart disease and kidney failure. When Conn's disease is caused by a tumor (benign adrenal adenoma), surgical resection is advised. This video demonstrates the case of a woman presenting with Conn’s disease. The preoperative work-up demonstrated a tumor located on the left adrenal gland. The patient presented an elevated aldosteronemia and the CT-scan demonstrated a 2cm left adrenal tumor. The patient is placed in a full lateral position, on the right side.
D Mutter, L Soler, J Marescaux
Surgical intervention
9 years ago
1551 views
108 likes
0 comments
15:51
Laparoscopic left adrenalectomy for Conn's adenoma: three trocar technique
Conn's disease is a condition in which the adrenal glands produce too much aldosterone. Prevalence estimates for Conn's syndrome is about 0.03-1.2% of the population with hypertension.
Many patients with Conn's disease have a high blood pressure that is difficult to control. This increases the risk of stroke, heart disease and kidney failure. When Conn's disease is caused by a tumor (benign adrenal adenoma), surgical resection is advised. This video demonstrates the case of a woman presenting with Conn’s disease. The preoperative work-up demonstrated a tumor located on the left adrenal gland. The patient presented an elevated aldosteronemia and the CT-scan demonstrated a 2cm left adrenal tumor. The patient is placed in a full lateral position, on the right side.
Laparoscopic right adrenalectomy for Conn's adenoma using ultrasonic shears
This video very clearly displays all the salient points of the performance of a right adrenalectomy with particular emphasis on the control of the vascular supply.
After controlling the venous landmarks, the authors move to control the main arteries of the adrenal gland. The authors identify the medial and superior pedicles and completely dissect them, gaining control with a one-clip application. The medial pedicle is only 1cm from the aorta. Severe bleeding may ensue, so they control the superior pedicle originating from the diaphragmatic artery with a clip. Identifying these arteries allows the authors to perform a complete removal of the adrenal gland and its surrounding fat. They clearly identify the renal artery, the renal vein just above it, and the inferior pedicle, which is also controlled with a simple clip application. At this point, the gland can be completely mobilized medially and inferiorly.
D Mutter, J Marescaux
Surgical intervention
11 years ago
1928 views
104 likes
15 comments
07:37
Laparoscopic right adrenalectomy for Conn's adenoma using ultrasonic shears
This video very clearly displays all the salient points of the performance of a right adrenalectomy with particular emphasis on the control of the vascular supply.
After controlling the venous landmarks, the authors move to control the main arteries of the adrenal gland. The authors identify the medial and superior pedicles and completely dissect them, gaining control with a one-clip application. The medial pedicle is only 1cm from the aorta. Severe bleeding may ensue, so they control the superior pedicle originating from the diaphragmatic artery with a clip. Identifying these arteries allows the authors to perform a complete removal of the adrenal gland and its surrounding fat. They clearly identify the renal artery, the renal vein just above it, and the inferior pedicle, which is also controlled with a simple clip application. At this point, the gland can be completely mobilized medially and inferiorly.
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.
EM Targarona Soler
Surgical intervention
11 years ago
278 views
34 likes
0 comments
09:26
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.
Laparoscopic left adrenalectomy for Conn's disease: virtual reality and exposure for vascular approach
This is a very detailed and didactic video demonstrating laparoscopic left adrenalectomy. All the critical steps are presented clearly and the surgical approach is explained at each stage. All the dissection is performed with only a hook cautery and atraumatic graspers. This is an excellent video for laparoscopic surgeons interested in learning adrenalectomy.

Key landmarks in this step are the splenic, adrenal, and renal veins—and the three main arterial pedicles of the latter that supply the left adrenal gland. The steady mobilization of the pancreas with retraction to the left with the spleen allows the authors to identify the renal vein, clear identification of which is essential. Steady dissection of the superior border of the renal vein enables positive identification of the adrenal vein. The authors dissect it circumferentially from the superior border of the renal vein up to the origin of the phrenic vein.
D Mutter, J Marescaux, L Soler
Surgical intervention
11 years ago
3154 views
67 likes
0 comments
14:22
Laparoscopic left adrenalectomy for Conn's disease: virtual reality and exposure for vascular approach
This is a very detailed and didactic video demonstrating laparoscopic left adrenalectomy. All the critical steps are presented clearly and the surgical approach is explained at each stage. All the dissection is performed with only a hook cautery and atraumatic graspers. This is an excellent video for laparoscopic surgeons interested in learning adrenalectomy.

Key landmarks in this step are the splenic, adrenal, and renal veins—and the three main arterial pedicles of the latter that supply the left adrenal gland. The steady mobilization of the pancreas with retraction to the left with the spleen allows the authors to identify the renal vein, clear identification of which is essential. Steady dissection of the superior border of the renal vein enables positive identification of the adrenal vein. The authors dissect it circumferentially from the superior border of the renal vein up to the origin of the phrenic vein.