Alexander S Rosemurgy, MD, Edward Choung, MD, Rita S Patel, MD, Harold Paul, BS, Sharona B Ross, MD. University of South Florida & Tampa General Medical Group
Laparo-Endoscopic Single Site (LESS) surgery is evolving as a safe, expeditious, and efficacious minimally invasive technique. By reducing the number of access incisions to a single incision hidden at the umbilicus, this approach offers improved cosmesis and potentially faster patient recovery. However, only a limited variety of LESS operations have been reported. Nonetheless, LESS surgery is progressively being applied to advanced laparoscopic procedures such as resection of an adrenal pheochromocytoma, as demonstrated by this video.
A 4.3cm pheochromocytoma was resected with the right adrenal gland from a 62 year old woman. After 10ml of bupivacaine was injected in the umbilicus where an 11mm vertical incision was made, preserving the umbilical ring, a single multi-trocar port was inserted. Four 5mm trocars were then placed into the port, allowing for a 5mm deflectable tip laparoscope, a rigid locking grasper, a bipolar energy source, and a Roticulator™ grasper. The liver was displaced cephalad by grasping the gallbladder and retracting it over the liver. The peritoneum overlying and attached to the tumor was grasped with the Roticulator™ grasper and retracted to the patient’s right. The adrenal gland was freed from the inferior vena cava; arterial and venous tributaries were divided using a bipolar energy device. The tumor and adrenal gland were freed from the right renal vein and the specimen was lifted off of the kidney and more dorsal tissues using a bipolar energy device. The tumor was not compressed and was minimally manipulated during the operation. Ultimately, the adrenal gland and tumor were freed from the underside of the liver. Hemostasis in the operative field was ensured and the specimen was placed into an extraction bag and removed en bloc; the incision was not extended beyond the initial 11mm length. Use of water-soluble lubricant gel facilitated extraction of a relatively large tumor through a relatively small incision. A dilute solution of bupivacaine was sprayed over the diagram and subphrenic spaces to reduce postoperative pain. The incision was closed with absorbable suture in a figure-of-eight fashion, the skin was approximated with interrupted absorbable sutures, and a sterile dressing was applied. The patient tolerated the procedure well and had an uneventful hospital course.
LESS surgery allows for adequate access to all quadrants of the abdomen and pelvis, promoting its application to many surgical disciplines for a wide variety of operations. This video documents that the LESS approach allows for sufficient visualization of and access to the peritoneal cavity for operations such as adrenalectomy for pheochromocytoma. LESS surgery is an approach that patients will embrace, promising no scar, less pain, and a quicker return to daily activities.
Session Number: VidTV2 – Video Channel Rotation Day 2
Program Number: V115
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