Transumbilical Single-access Laparoscopic Left Adrenalectomy for Giant Symptomatic Pheocromocytoma

Giovanni Dapri, MD, PhD, FACS, Viola Zulian, MD, Maria Bortes, MD, Perrine Mathonet, MD, Guy-Bernard Cadiere, MD. European School of Laparoscopic Surgery, Brussels, Belgium.

Background: Single-access laparoscopy (SAL) has been reported for adrenal gland surgery. This technique can also be applied for patients presenting giant and symptomatic diseases such as pheochromocytoma.

Video: A 17-year-old woman was admitted to the hospital for severe headaches, palpitations, and tachycardia along with tremulousness, dizziness, and vomiting. A symptomatic left-side single location adrenal pheochromocytoma was diagnosed and a transumbilical SAL left adrenalectomy was proposed. The patient was placed in a semi-lateral right-sided decubitus. The technique was performed using an 11-mm reusable trocar to accommodate a 10-mm, 30° rigid and regular length scope besides curved reusable instruments (Karl Storz Endoskope, Tüttlingen, Germany). The procedure started with the opening of the splenocolic ligament and, after have mobilized the splenopancreatic block medially, the adrenal lesion was evidenced. Probably due to the size of the lesion and compressed structures, only two main adrenal vessels were found: vein and mid-artery. Both vessels were dissected and divided between 5-mm non-absorbable clips. The specimen was retrieved transumbilically in a custom-made plastic bag.

Results: Laparoscopic time was 129 minutes, estimated blood loss 20 cc, and the final scar length measured 16-mm. The symptomatic status of the patient was resolved immediately. The patient was discharged from the intensive care unit after 3 days and from the hospital after 6 days. After 6 months she is doing well.

Conclusions: Transumbilical SAL left adrenalectomy for giant symptomatic pheochromocytoma is feasible and safe. In young ladies, it offers an excellent cosmetic result, avoiding large abdominal trauma.

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