A
Journal Surgery
Available online at ScienceDirect www.sciencedirect.com
Elsevier Masson France EM consulte www.em-consulte.com/en
ELSEVIER MASSON
:
VISCERAL SURGERY VIDEOS
Laparoscopic left adrenalectomy for suspected adrenocortical carcinoma (with video)
CrossMark
S. Gaujouxa,b, G. Goudarda,b, S. Bonneta, B. Dousset ª,*,b
a Department of Digestive and Endocrine Surgery, Cochin Hospital, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
b Université Paris Descartes, 12, rue de l’École-de-Médecine, 75006 Paris, France
Available online 3 October 2014
KEYWORDS Adrenalectomy; Laparoscopy; Adrenocortical carcinoma
Laparoscopic adrenalectomy has become the standard operation in the surgical manage- ment of virtually all benign adrenal tumors. This procedure is associated with an almost nil mortality, a 10 to 15% morbidity and a conversion rate below 3% [1-3]. For adrenal tumors suspected to be adrenocortical cancer without local invasion (ENSAT stade 1 or 2), laparoscopic approach remains controversial but when performed, should be associated with periadrenal fat tissue resection without capsular effraction.
This video (Video S1) shows a left transperitoneal lateral adrenalectomy with positioning in right lateral decubitus. The dissection is achieved using scissors, bipolar coagulation, and harmonic scalpel. Four trocars are placed beneath the costal margin. Exposure starts with a complete mobilization of the left colonic flexure, avoiding injury to the renal capsule. The inferior edge of the pancreas is visualized and the spleen mobilized on its inferior part. The anterior face of the left renal vein is exposed allowing to individualize and clip the left adrenal vein. After main adrenal vein section, a posterior dissection is performed in contact with the diaphragm and its left crux to mobilize the adrenal gland on its posterior aspect. The gland is mobilized together with all periadrenal fat tissue to prevent tumor disruption, with a special attention to the pancreas tail, whose injury may be associated with postoperative pancreatic fistula or collection. Once fully mobilized, the adrenal gland is extracted after being placed in a plastic bag, through an enlarged trocar orifice, whose fascia is to be later closed. A suction drain is usually not necessary. Pathology showed a 28 mm adrenocortical adenoma with Weiss 3 score.
* Corresponding author.
E-mail address: bertrand.dousset@cch.aphp.fr (B. Dousset).
Disclosure of interest
The authors declare that they have no conflicts of interest concerning this article.
Appendix A. Supplementary data
Supplementary data associated with this article can be found, in the online version, at http://dx.doi.org/ 10.1016/j.jviscsurg.2014.09.010.
References
[1] Gagner M, Lacroix A, Bolte E. Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 1992; 327(14):1033.
[2] Gaujoux S, Bonnet S, Leconte M, et al. Risk factors for conversion and complications after unilateral laparoscopic adrenalectomy. Br J Surg 2011;98(10):1392-9.
[3] Assalia A, Gagner M. Laparoscopic adrenalectomy. Br J Surg 2004;91 (10):1259-74.