Single-Port Laparoscopic Adrenalectomy for Ganglioneuroma: A Case Report

Abstract

Introduction: Single-port laparoscopy has gained popularity in both the adult and the pediatric populations. Experience thus far is limited in single-port laparoscopy for adrenalectomy. We present a 4-minute video of a single-port laparoscopic adrenalectomy performed for benign disease in a girl. Methods: The patient was a 16-year-old girl (49 kg) who was found to have an incidental 3.2-cm calcified mass in the right adrenal gland. The patient was normotensive and clinically asymptomatic. Urine metanephrines, Vanillylmandelic acid (VMA), Homovanillic acid (HVA), norepinephrine, epinephrine, and dopamine levels were normal. At the time of surgery, the patient was placed in a lateral decubitus position with the right flank elevated. A 2-cm transverse, muscle-splitting incision was made in the flank at the mid-axillary line, and the TriPortTM (Advanced Surgical Concepts, Wicklow, Ireland) was placed into the peritoneum. A 5-mm, 30-degree endoscope and two 5-mm straight-working instruments were used for dissection. A 5-mm self-retaining retractor was used to retract the liver. The medial aspect of the gland was dissected from the inferior vena cava to expose the main adrenal pedicle. The main adrenal pedicle was ligated with 5-mm titanium clips and divided. Dissection continued superiorly, where the superior adrenal vein was clipped and divided. The inferior aspect of the adrenal gland was freed from the superior aspect of the kidney, and the inferior adrenal pedicle was clipped and divided. The adrenal gland was removed intact. Results: The operative time was 124 minutes with minimal blood loss. The patient began a liquid diet the night of surgery. She was discharged to home on the third postoperative day. The pathology revealed mature ganglioneuroma. At her 6-month follow-up visit, the results of renal ultrasonography and urinary catecholamines remained normal. Conclusion: Since the initial description in the adult literature in 1992,1 laparoscopic adrenalectomy has become the accepted approach for children with benign disease.2 The identification of incidental adrenal lesions is increasing in the pediatric population, and resection is recommended because malignancy may be found in up to 30%.3 The flank approach allowed for direct access to the retroperitoneum. As experience increases, the single-port laparoscopic approach through the umbilicus can provide a virtually scarless operation. This group of patients may be excellent candidates for a single-port laparoscopic approach to adrenalectomy. No competing financial interests exist. Runtime of video: 4 mins Presented at the International Pediatric Endosurgery Group's 20th Annual Congress of Endosurgery in Children, May 3–7, 2011, Prague, Czech Republic.