Jara Hernandez Gutierrez, Aurelio Francisco Aranzana Gomez, Juan S Malo Corral, Beatriz Muñoz Jimenez. CH Toledo
Introduction: After the 1st laparoscopic adrenalectomy described in 1992 (Gagner), the laparoscopic lateral transabdominal approach has proved to be the one of choice. It provides an easy anatomical orientation, the technique is similar to other traditional laparoscopic procedures and is the one described in most of the literature. On the other hand, 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. Currently there is controversy about which is the approach of choice, having to take into account the learning curve necessary for the retroperitoneal approach and the reduced number of patients with adrenal pathology subsidiary of surgical manegement.
The objetive is to demonstrate the safety and efficacy of the standardized laparoscopic approach of the left adrenal gland with 3 trocars for selected cases.
Methods and Procedures: Clinical case: 43-year-old man, resistant hypertension despite concurrent use of three antihypertensive agents of different classes, with biochemical and radiological diagnosis of left adrenal adenoma with primary hyperaldosteronism. Demonstrative video of the technical steps in a standardized way that we propose for laparoscopic left adrenalectomy only using 3 trocars.
Results: Full laparoscopic surgical approach in right lateral decubitus position: 3 trocars – lateral transabdominal approach.
Steps:
1. Laparoscopic liberation of the splenic flexure of the colon for the colo-spleen-pancreato-gastric en block mobilization until identification of the left pillar,
2. dissection of the medial border of the gland, identification of left renal and diaphragmatic vein, as well as the adrenal vein which is dissected and clipped,
3. dissection of the lateral edge of the adrenal gland,
4. lower pole dissection of the gland completing the resection with Ligasure®.
Operating time was 60 min. The patient presented a successful postoperative recovery, being discharged 24 hours after the intervention. Asymptomatic, the patient does not need antihypertensive agents after 1 year of follow-up.
Conclusion(s): Laparoscopic adrenalectomy is an effective and safe technique that associates scarce morbidity and mortality, and it has evident postoperative advantages for the patient. The standardization of the procedure allows reducing the number of trocars, maintaining the safety and effectiveness of the minimally invasive approach.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94342
Program Number: V287
Presentation Session: Video Loop Day 2
Presentation Type: VideoLoop