V867: Laparoscopic adrenalectomy : Step-by-step surgical skills

Video

Introduction and Objectives
To introduce step-by-step skills and to show the learning curve of pure laparoscopic adrenalectomy performed by a single surgeon.

Methods
From October, 2008 to September, 2011, 74 patients out of 112 who were diagnosed as adrenal mass received pure laparoscopic adrenalectomy. 8 cases were bilateral, and 66 cases were unilateral. After placing the patient in flank position, 12mm camera port is inserted near umbilicus. If the patient is obese, camera port is lateralized. Two 5mm working ports are placed at the cross-sections of midclavicle line, anterior axillary line and subcostal margin. 2mm port for liver retraction is placed just below the xiphoid process if the mass is on the right side. When performing the right adrenalectomy, avascular triangle formed by vena cava, liver, renal vein is identified. Adrenal gland is lifted up using forcep or suction, and adrenal vein is ligated. Inferior phrenic vascular supply at the liver margin and renal hilum vascular supply at the upper pole margin of kidney are secured in order. And then, adrenal gland is removed. When performing left adrenalectomy, line of Toldt, splenocolic ligament and splenic flexure is incised. The plain between descending colon, pancreas, spleen and perirenal fascia is splitted and flipped over all the way to the medial side. After identifying renal vein, adrenal vein is ligated. Following procedures are the same as on the right side. The camera scope is replaced to 5mm and inserted into 5mm working port, and 12mm port is used for delivering specimen. Drain is not inserted.

Results
There was significant improvement in average operation time(90 vs. 53min, p=0.003) and decrease in estimated blood loss(130 vs, 50mL, p
Conclusions
With the knowledge of anatomical structures near the adrenal glands, the surgical techniques introduced here in this video clip will help the surgeon with little experience on adrenalectomy to overcome the learning curve.

Funding: none