Retroperitoneal hand-assisted laparoscopic surgery for endoscopic adrenalectomy

Abstract

Although hand-assisted laparoscopic surgery (HALS) is very common in various laparoscopic procedures, it is rarely used for retroperitoneal endoscopic adrenalectomy because of the small working area. The authors evaluate HALS in endoscopic adrenalectomy with respect to its use as a rescue procedure in complicated cases. In their department, 47 patients underwent endoscopic adrenalectomies between 1998 and 2004. Mainly because of complicated anatomy, three primary aldosteronism cases were converted to retroperitoneal HALS. This involved making an additional 6 cm skin incision, into which the surgeon's left hand was inserted, with the palm used to create a sufficient visual field and working area. The fingers were used for tactile sensation and blunt resection. For these three cases, successful retroperitoneal HALS in endoscopic adrenalectomy resulted in no mortality or morbidity. These findings indicate that this procedure is a feasible technique for complicated benign adrenal tumor cases.

Forty-Three-Year-Old Female with Dopamine Secreting Pheochromocytoma of the Adrenal Gland

“…Definitive treatment of any pheochromocytoma is surgical excision. Studies also have shown laparoscopic resection of large adrenal tumors to be safe [ 11 ]. The resection of our dopamine secreting pheochromocytoma was completed with robotic assisted laparoscopic adrenalectomy without complication.…”

An exclusively dopamine secreting paraganglioma in the retroperitoneum: a first clinical case in Korea

“…Laparoscopic surgery is considered the standard surgical option. Hand-assisted laparoscopic surgery has been adapted for the removal of large tumors and for the rescue of operative procedures in complicated cases of laparoscopic surgery [9]. …”

Delayed Postoperative Hemorrhage After Laparoscopic Adrenalectomy

“…An LA was performed using the standard lateral retroperitoneal approach. 21 The tumor was located in the inferior part of the left adrenal gland. The left superior adrenal artery, two branches of the left inferior adrenal artery, and the left adrenal vein (central vein) observed in the inferior part of the gland were dissected and ligated with clips.…”