Ranbir Singh, MD, MAS, Margaret M Frisella, RN, Mary Quasebarth, RN, L Michael Brunt. Washington University School of Medicine
INTRODUCTION: We examined anatomic structures visible at each step of laparoscopic right and left adrenalectomy (LA).
METHODS: Full videos of left (N=12) and right (N=5 )LA were reviewed by two surgeons. Major anatomical structures seen at each operative step were recorded. Steps analyzed were: Right adrenalectomy: Step 1) mobilize liver; 2) medial dissection; 3) adrenal vein isolation; 4) inferior dissection; 5) adrenal off kidney; 6) detachment. Left adrenalectomy:Step 1) division splenorenal ligament; 2) develop plane pancreas/kidney; 3) mobilization medial/lateral borders adrenal; 4) adrenal vein isolatoin; 5) dissection adrenal off kidney; 6) detachment. Structures were identified as YES/NO and results expressed as percentage total N of cases seen at each step.
RESULTS: Structures identified at each step are shown (table). Not all were the same on both sides due to differences in the anatomy.
CONCLUSIONS: Relevant anatomic structures can be seen in a high percentage of cases of LA at most steps after initial mobilization. For right adrenalectomy, the IVC, and left adrenalectomy, the pancreas and splenic vessels are seen early and should be positively identified throughout to prevent injury.
| Right adrenalectomy (N=5) Step | Adrenal/tumor | Kidney | IVC | Adrenal vein | Adrenal arteries | Psoas | |
| 1 | 20% | 20% | 100% | 20% | 0 | 0 | |
| 2 | 80% | 80% | 100% | 80% | 80% | 0 | |
| 3 | 100% | 80% | 100% | 100% | 80% | 40% | |
| 4 | 100% | 100% | 100% | NA | 100% | 100% | |
| 5/6 | 100% | 100% | 100% | NA | NA | 100% | |
| Left Adrenalectomy (N=12) Step | Adrenal/tumor | Tail pancreas | Splenic artery/vein | Kidney | Renal vein | Adrenal vein | Adrenal arteries |
| 1 | 25% | 100% | 100% | 50% | 0 | 0 | 0 |
| 2 | 83.3% | 100% | 100% | 83.3% | 0 | 50% | 0 |
| 3 | 100% | 100% | 100% | 100% | 0 | 83.3% | 91.6% |
| 4 | 100% | 100% | 100% | 100% | 91.6% | 100% | 100% |
| 5/6 | 100% | 100% | 100% | 100% | 91.6% | NA | NA |
NA=not applicable.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88021
Program Number: P823
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster