Page 37 - WJOLS - Laparoscopic Journal

Laparoscopic Adrenalectomy: Surgical Technique

medial surface of adrenal gland thee adrenal vessels is and retrieved through a thoracic port. The diaphragm was
exposed and ligation. After complete dissection of the gland suture repaired with intracorporeal knot tying and chest
then placed into a specimen retrieval bag and removed. This tube was placed. The outcomes are—(1) No perioperative
surgical approach is not popular option because need more complications (2) Operating time was 2.5 to 6.5 hours
surgical experience and limitation of working space. 3,7 (3) Blood loss was 50 to 500 cc. 11
Rubinstin et al report a comparison of perioperative
outcome between transperitoneal approach and lateral Single Access Retroperitoneal Adrenalectomy
retroperitoneal approach in 57 consecutive benign adrenal Single access laparoscopic surgery is becomes a new trend
conditions. Finding that both surgical techniques are safe. in minimally invasive surgery. This surgical access is need
There are not different in operative time (130 vs 126.5 articulating or bent instrumentation insert to adjacent trocar
minutes), blood loss, postoperative pain, length of hospital in same incision to allow triangulation intracorporeally during
stay and postoperative complication. 9 surgery (Figs 4A and B). Now development of new
Zusuki et al report clinical outcomes of the trans- laparoscopic access ports allowing several instruments to
peritoneal, lateral transperitoneal and lateral retroperitoneal be inserted through different cannulae of a single port. 12,13
approach. This article conclusion is—(1) Lateral Hirano et al report technique of single incision
transperitoneal approach is proper for a tumor is more than retroperitoneoscopic adrenalectomy. The patient was placed
5 cm and/or the surgeon is not yet skilled in laparoscopic in lateral decubitus position with slight flexion. A 4.5 cm
adrenalectomy (2) Lateral retroperitoneal approach is skin incision was performed below the twelfth rib in the
suitable, if the surgeon has performed at least 20 operations, midaxillary line. Balloon dilataion combined with finger
the adrenal tumor is unilateral and the lesion is less than dissection were used to create working space in
5 cm. 10 retroperitoneal. A rectoscope tube, 4 cm diameter, was
inserted for camera and working instrument to perform
Transthoracic Approach
adrenalectomy port without carbon dioxide insufflations.
Gill et al report “Thoracoscopic transdiaphragmmatic This operation was successful in 98.1%. The average
adrenalectomy” in 3 patients with prior history of extensive duration of surgery was 203 minutes, and the mean estimated
abdominal surgery. This technique was performed after blood loss was 252 cc. Postoperative major complications,
double lumen endotracheal intubation without pneumo- including fulminant hepatitis and pulmonary thrombosis,
insufflation and the patient is placed in the prone position. were observed in two patients (3.7%). 14
Four port transthoracic approaches were used. The Walz et al report outcome of single-access
diaphragm was incised under thoracoscope vision, and then retroperitoneoscopic adrenalectomy (SARA) in 47 patients
enters to retroperitoneal space to identification of adrenal with benign adrenal tumor. SARA results are need long
gland. Adrenal vasculature was controlled and complete operative time, decrease postoperative pain when compare
mobilization of adrenal gland. The specimen was entrapped with traditional retroperitoneoscopic three-port approach.

A B
Figs 4A and B: Single port with three working channel and articulated instrument for single access laparoscopic surgery 13
World Journal of Laparoscopic Surgery, May-August 2010;3(2):91-97 95