Transumbilical Single-Access Laparoscopic Right Adrenalectomy with 1.8-mm Epigastric Trocarless Grasping Forceps

Abstract

Abstract

Introduction:

Laparoscopic adrenalectomy has been reported in supine, lateral, and prone patient positioning. ¹ Recently, this procedure has been showed to be feasible also by single-access laparoscopy. ² The authors report the technique with the patient in a supine position, with the umbilicus as the 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 semilateral left-sided decubitus. The technique was performed using an 11-mm reusable trocar to accommodate a 10-mm, 30° rigid and regular length scope, in addition to curved reusable instruments according to DAPRI (Karl Storz Endoskope). The right liver lobe was retracted using a 1.8-mm trocarless grasping forceps according to DAPRI (Karl Storz Endoskope), inserted percutaneously under the 12th right rib.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. After having identified the adrenal gland, the inferior adrenal arteries and veins were clipped between 5-mm clips. The middle adrenal vein and artery were clipped as well, and the superior edge of the gland was freed. A plastic bag (used for suction drain) was custom made and introduced in the abdomen through the 11-mm trocar. The specimen was removed transumbilically, and the procedure finished with the closure of the access site by absorbable figures of eight sutures.

Results:

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

Conclusions:

With this technique of transumbilical single-access laparoscopic right adrenalectomy, 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 is consultant for Karl Storz-Endoskope, Tuttlingen, Germany. The other authors have no conflicts of interest or financial ties to disclose.

Running Time: 6 mins 9 secs