Aurelio Francisco Aranzana Gomez, Jara Hernandez Gutierrez, Juan S Malo Corral, Beatriz Muñoz Jimenez. CH Toledo
Introduction: The posterior retroperitoneoscopic adrenalectomy (PRA), described in 1995 (Waltz), has proven to be a safe technique and effective for the surgical management of several adrenal pathologies. The advantages include direct access to the adrenal gland, without the need for visceral mobilization or lysis of adhesions from previous abdominal operations and the ability to perform a bilateral adrenalectomy without repositioning the patient.
The objective is to demonstrate the safety and efficacy of the retroperitoneoscopic approach for selected cases. We present a video that includes a clinical case with this technique.
Methods and Procedures: 58 year old women AP-laparotomic cholecystectomy, post-cholecystectomy pancreatitis, HT, cesarean section. Follow-up for bilateral SR adenomas and subclinical Cushing with hypertension (normal catecholamines, post-dexamethasone cortisol: 2.7). CT: Nodule of 38 x 29 mm suggestive of adenoma, and a nonspecific nodular thickening in left SR. Physical examination IMC-27, scars of medial laparotomy, subcostal and infraumbilical.
Results: Decubitus prone Jackknife position. Access through 2-cm minilaparotomy before and below the tip of the 12th rib. Creation of space by digital dissection. 3 Trocars. Pneumoretroperitoneum at high flow (25mmHg). Opening of the Zuckerkandl fascia and localization of the superior renal pole, identification of the peritoneum and posterior muscular plane. Dissection of medial edge of the adrenal gland. Attention cava perforation at the level of the ostium of the SRD vein, we proceed to raise the intraabdominal pressure to 30 mmHg, avoid aspiration, mobilization of the gland for better access and subsequent control with clips, no drainage and control of adrenal vessels. Definitive result of the specimen: adenoma.
Conclusion(s): In selected cases, the retroperitoneal approach in prone position for the resection of the adrenal gland is safe and effective. It offers quick access to the gland along with the advantages of the minimally invasive approach. Although it needs to be performed by experienced surgeons due to its great complexity and technical requirements.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94390
Program Number: V237
Presentation Session: Video Loop Day 2
Presentation Type: VideoLoop