V867 LAPAROSCOPIC ADRENALECTOMY STEP-BY-STEP SURGICAL SKILLS

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You have accessJournal of UrologyOncology (TCC & Adrenal) & Teaching Techniques1 Apr 2012V867 LAPAROSCOPIC ADRENALECTOMY STEP-BY-STEP SURGICAL SKILLS Hyung Joon Kim, Hyun Hwan Sung, Bumsoo Park, Bong Hee Park, Seong Il Seo, Seong Soo Jeon, Hyun Moo Lee, and Byong Chang Jeong Hyung Joon KimHyung Joon Kim Seoul, Korea, Republic of Korea More articles by this author , Hyun Hwan SungHyun Hwan Sung Seoul, Korea, Republic of Korea More articles by this author , Bumsoo ParkBumsoo Park Seoul, Korea, Republic of Korea More articles by this author , Bong Hee ParkBong Hee Park Seoul, Korea, Republic of Korea More articles by this author , Seong Il SeoSeong Il Seo Seoul, Korea, Republic of Korea More articles by this author , Seong Soo JeonSeong Soo Jeon Seoul, Korea, Republic of Korea More articles by this author , Hyun Moo LeeHyun Moo Lee Seoul, Korea, Republic of Korea More articles by this author , and Byong Chang JeongByong Chang Jeong Seoul, Korea, Republic of Korea More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.961AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To introduce step-by-step skills and to show the learning curve of pure laparoscopic adrenalectomy performed by a single surgeon. METHODS From October, 2008 to September, 2011, 74 patients out of 112 who were diagnosed as adrenal mass received pure laparoscopic adrenalectomy. 8 cases were bilateral, and 66 cases were unilateral. After placing the patient in flank position, 12mm camera port is inserted near umbilicus. If the patient is obese, camera port is lateralized. Two 5mm working ports are placed at the cross-sections of midclavicle line, anterior axillary line and subcostal margin. 2mm port for liver retraction is placed just below the xiphoid process if the mass is on the right side. When performing the right adrenalectomy, avascular triangle formed by vena cava, liver, renal vein is identified. Adrenal gland is lifted up using forcep or suction, and adrenal vein is ligated. Inferior phrenic vascular supply at the liver margin and renal hilum vascular supply at the upper pole margin of kidney are secured in order. And then, adrenal gland is removed. When performing left adrenalectomy, line of Toldt, splenocolic ligament and splenic flexure is incised. The plain between descending colon, pancreas, spleen and perirenal fascia is splitted and flipped over all the way to the medial side. After identifying renal vein, adrenal vein is ligated. Following procedures are the same as on the right side. The camera scope is replaced to 5mm and inserted into 5mm working port, and 12mm port is used for delivering specimen. Drain is not inserted. RESULTS There was significant improvement in average operation time(90 vs. 53min, p=0.003) and decrease in estimated blood loss(130 vs, 50mL, p<0.001) of the latter 33 unilateral laparoscopic adrenalectomy cases compared to the prior 33 cases. CONCLUSIONS With the knowledge of anatomical structures near the adrenal glands, the surgical techniques introduced here in this video clip will help the surgeon with little experience on adrenalectomy to overcome the learning curve. Table. Learning curve analysis Case 1-33 Case 34-66 p-value Sex (M/F) 23/10 21/12 0.602a Age (year) 48.48±12.75 50.54±11.32 0.490b BMI (kg/m2) 24.88(22.08-27.55) 26.91(23.19-28.24) 0.284c Laterality (Rt/Lt) 17/16 17/16 1.000a Tumor size (cm) 4.5(2.65-6.00) 3.5(2.05-5.25) 0.313c POD (days) 4.0(3.0-6.5) 4.0(3.0-5.0) 0.698c EBL (mL) 130(50-375) 50(30-100) <0.001c OP time (min) 90(54-137) 53(40-70) 0.003c IntraOp Cx (No/Yes) 28/5 31/2 0.427a a Pearson's Chi-square test, b Student t-test, c Mann-Whitney U test © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e353-e354 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hyung Joon Kim Seoul, Korea, Republic of Korea More articles by this author Hyun Hwan Sung Seoul, Korea, Republic of Korea More articles by this author Bumsoo Park Seoul, Korea, Republic of Korea More articles by this author Bong Hee Park Seoul, Korea, Republic of Korea More articles by this author Seong Il Seo Seoul, Korea, Republic of Korea More articles by this author Seong Soo Jeon Seoul, Korea, Republic of Korea More articles by this author Hyun Moo Lee Seoul, Korea, Republic of Korea More articles by this author Byong Chang Jeong Seoul, Korea, Republic of Korea More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...