Transperitoneal Laparoscopic Adrenalectomy in Children

Abstract

Introduction: The use of a minimally invasive approach for adrenalectomy is poorly defined in pediatric patients, although laparoscopic adrenalectomy is considered a standard procedure in adults.1–4 The aim of our video is to describe the safety and feasibility of transperitoneal lateral laparoscopic adrenalectomy in children based on surgical skills and results. Surgical Procedure: The patient was placed in a reverse Trendelenburg semilateral position over a flank lift. A 10 mm Hg pneumoperitoneum was created using a 10- to 12-mm Hasson's trocar and three 5-mm trocars were inserted, as shown in the video. Left Adrenalectomy: A plane along the anterior surface of the kidney, lateral and dorsal to the spleen and tail of pancreas, was established and the splenic ligaments were divided. The dissection proceeded along the anterior surface of the kidney and adrenal gland until the inferior and medial border. The main adrenal vein and artery were isolated and sectioned. The dissection proceeded in a superolateral direction until complete mobilization of the gland. Right Adrenalectomy: The liver was retracted and the right lobe was mobilized, thus revealing the anterior surface of the adrenal gland. The lateral border of the inferior vena cava was isolated to identify the adrenal vein transacted. The dissection proceeded in a mediolateral and superoinferior direction, until complete mobilization of the gland. Materials and Methods: This is a retrospective study of four pediatric laparoscopic adrenalectomies (two right and two left) performed at our center. Preoperative workup included endocrinologic and radiologic investigation to determine the secretory activity, size, and local extent of the lesion. Results: The mean age was 87 months. Indications for surgery were two neuroblastomas, one aldosterone-secreting adrenocortical tumor, and one adrenocortical nodular hyperplasia. The mean size of the lesions was 3.23 cm at the pathologic examination. No intraoperative complications or conversions occurred. The average operating time was 85 minutes for right and 125 minutes for left adrenalectomies. The mean hospital stay was 3.75 days. At 15 months, the follow-up was negative. Conclusions: Transperitoneal laparoscopic adrenalectomy is a safe, feasible, and reproducible approach for the treatment of benign and malignant adrenal masses in children. Furthermore, this approach offers many advantages, including shortening of operating times and postoperative hospital stays, as well as reduction of blood loss and complications; also, a large working space with a clear view of the structure that permitted to perform a controlled resection.5,6 The authors have nothing to disclose. Runtime of video: 8 mins