Erratum

Abstract

Background: Rarely, a posterior mediastinal mass may mimic an adrenal tumor on preoperative computed tomography scan. The intraoperative discovery that a mass thought to be associated with the adrenal gland actually is above the diaphragm in the posteroinferior mediastinum poses a challenge for the laparoscopic surgeon. Conversion to a thoracotomy or to videothoracoscopy incurs additional morbidity and risk for the patient. Materials and Methods: We describe a technique for the transdiaphragmatic removal of a benign mass from the posterior mediastinum. A posterior mediastinal tumor was detected during a laparoscopic procedure for a suspected right adrenal tumor. Frozen section proved benign, and the mass was resected laparoscopically via transdiaphragmatic access to the posterior mediastinum. Results: No complications were noted during or after surgery. The patient was ready for discharge from the hospital on postoperative day 1. Conclusions: Transdiaphragmatic resection was done successfully instead of conversion to a thoracotomy or thoracoscopic procedure for a benign posterior mediastinal tumor found incidentally during laparoscopic surgery for a presumed adrenal lesion. This transdiaphragmatic approach can be applied to selected benign mediastinal masses.

Timing of percutaneous cholecystostomy affects conversion rate of delayed laparoscopic cholecystectomy for severe acute cholecystitis

“…Inappropriate timing of laparoscopic cholecystectomy for acute cholecystitis may lead to higher conversion rate, leading to increased time for convalescence and related complications [1][2][3]. Timing of interval LC following PC is still controversial and is based on the same assumptions that early surgical intervention may lead to performing surgery under fewer fibrotic and inflammatory changes that may interfere with careful dissection of the complex anatomy at the triangle of Calot [11,[17][18][19][20][21][22][23][24][25][26][27][28].…”

“…Although LC following PC is performed under better medical conditions, the conversion rate to open surgery is relatively high, ranging from 8 to 31 % [17][18][19][20]. Timing of laparoscopic cholecystectomy following PC is controversial, as some studies have demonstrated the benefit of early intervention, while others preferred delayed surgery to reduce the conversion rate [11,[17][18][19][20][21][22][23][24][25][26][27][28]. Surprisingly, however, the issue of the timing of PC-the time lapse from onset of symptoms to drainage or from admission to hospital to performance of PC-has not yet been studied.…”

Mass in the Adrenal Region: Not Always of Adrenal Origin: A Diagnostic Dilemma

“…An adrenal mass is usually resected by either open or laparoscopic adrenalectomy while the standard approach for mediastinal neurogenic tumours is via posterolateral thoracotomy. The intraoperative discovery of a presumed adrenal mass(operated transabdominally) to be supradiaphragmatic poses tremendous challenge for a surgeon less versed with thoracotomy procedure.Though transdiaphragmatic resections of such supradiaphragmatic neurogenic tumors has been described in literature, [12] such expertise may not be available at all time. We advise to exert caution in adrenal masses with posterior mediastinal extension and explore them in liason with vascular teams.…”