We use cookies to offer you an optimal experience on our website. By browsing our website, you accept the use of cookies.
Filter by
Specialty
View more
Clear filter Media type
View more
Clear filter Category
View more
Publication date
Sort by:
Posterior retroperitoneoscopic revision of the right suprarenal space for recurrence of pheochromocytoma
A 36-year-old woman came to the attention of the endocrinologist for a recent onset of headache and tachycardia and an US finding of a 1.8cm nodule in the right suprarenal space.
At age 25, she was submitted to an anterior laparoscopic transperitoneal right adrenalectomy for a 5cm pheochromocytoma. At age 33, she underwent laparoscopic cholecystectomy.
The diagnostic work-up revealed raised urinary metanephrine and normetanephrine and an MRI finding of a 1.5cm nodule in the right suprarenal space, with smaller satellite nodules in the retrocaval space.
A surgical revision of the right suprarenal space was indicated and the posterior retroperitoneal approach was chosen, to warrant better reach of the nodules and allow direct exposure of the retrocaval and retrohepatic spaces.
The operative time was 210 minutes. The patient recovered with no major complications and was discharged on her 4th postoperative day. Her symptoms recovered and she was found with lowered metanephrines at follow-up. An 18-FDG PET-CT scan performed 6 months after the operation showed no abnormal metabolic activity within her body.
M Lotti, B Carrara, L Moroni, S Cassibba, D Gianola, M Giulii Capponi
Surgical intervention
3 years ago
849 views
40 likes
0 comments
16:24
Posterior retroperitoneoscopic revision of the right suprarenal space for recurrence of pheochromocytoma
A 36-year-old woman came to the attention of the endocrinologist for a recent onset of headache and tachycardia and an US finding of a 1.8cm nodule in the right suprarenal space.
At age 25, she was submitted to an anterior laparoscopic transperitoneal right adrenalectomy for a 5cm pheochromocytoma. At age 33, she underwent laparoscopic cholecystectomy.
The diagnostic work-up revealed raised urinary metanephrine and normetanephrine and an MRI finding of a 1.5cm nodule in the right suprarenal space, with smaller satellite nodules in the retrocaval space.
A surgical revision of the right suprarenal space was indicated and the posterior retroperitoneal approach was chosen, to warrant better reach of the nodules and allow direct exposure of the retrocaval and retrohepatic spaces.
The operative time was 210 minutes. The patient recovered with no major complications and was discharged on her 4th postoperative day. Her symptoms recovered and she was found with lowered metanephrines at follow-up. An 18-FDG PET-CT scan performed 6 months after the operation showed no abnormal metabolic activity within her body.
Cystic pheochromocytoma: anatomical landmarks for laparoscopic resection
Surgery for pheochromocytoma is often considered difficult due to local anatomical conditions which are often associated with a hypervascularization and inflammatory reaction. This video demonstrates the case of a patient presenting with a 5cm pheochromocytoma with a necrotic core. Because the patient has a low BMI, the intraoperative anatomy is magnified and all anatomical landmarks are perfectly identified right before dissection. The lesion is eventually embedded in the liver. Its approach and dissection allow to determine the constraints related to adrenal surgery, and particularly regarding the impossibility to manipulate the lesion other than with soft retraction.
D Mutter, J Marescaux
Surgical intervention
4 years ago
2171 views
106 likes
0 comments
15:04
Cystic pheochromocytoma: anatomical landmarks for laparoscopic resection
Surgery for pheochromocytoma is often considered difficult due to local anatomical conditions which are often associated with a hypervascularization and inflammatory reaction. This video demonstrates the case of a patient presenting with a 5cm pheochromocytoma with a necrotic core. Because the patient has a low BMI, the intraoperative anatomy is magnified and all anatomical landmarks are perfectly identified right before dissection. The lesion is eventually embedded in the liver. Its approach and dissection allow to determine the constraints related to adrenal surgery, and particularly regarding the impossibility to manipulate the lesion other than with soft retraction.
Laparoscopic resection of extra-adrenal paraganglioma
Introduction
Paragangliomas are rare tumors that arise from extra-adrenal chromaffin cells. These tumors arise from dispersed paraganglia that tend to be symmetrically distributed in close relation to the aorta and to the sympathetic nervous system. Paragangliomas have a higher malignancy potential than adrenal pheochromocytomas.
Laparoscopy has the advantage of optical magnification and provides better visualization of small vessels, which allows for meticulous dissection during tumor excision. Laparoscopic resections of such tumors have been described in isolated cases.

Material and methods
We present the case of a 16-year-old female patient who presents with repeated urinary tract infection. An ultrasound demonstrates the presence of a retropancreatic mass. The study was completed by abdominal CT-scan and PET-scan (123-MIBG) where a solid mass of 4.5cm in diameter, homogeneous, encapsulated, without calcifications, located between the third duodenal portion (which is displaced anteriorly) and the inferior vena cava from the level of the right renal vein to the level of the right renal lower pole, is found. The patient presents MIBG (metaiodobenzylguanidine) tracer uptake in the Iodine-123-MIBG scintigraphy, suggesting the diagnosis of adrenal medullary tumor. The hormonal study shows a significant increase in plasmatic normetanephrine (25 times the normal upper limit). A genetic study has found no mutation of the most frequent responsible genes.
Given radiological and hormonal findings, laparoscopic surgery is decided upon with suspected diagnosis of extra-adrenal paraganglioma.

Discussion
In this video, we present a laparoscopic approach to this mass, using an 11mm optical trocar and four 5mm working trocars. As can be appreciated, a very careful dissection is carried out to separate the mass from adjacent structures, dissecting small vessels that drain directly into the inferior vena cava.
Final pathology reports a 5cm retroperitoneal paraganglioma, with vascular invasion. In the immunohistochemical study, cells are positive for Synaptophysin and Chromogranin A. The postoperative course was uneventful, and the patient was discharged on postoperative day 4.
The laparoscopic excision of paraganglioma is safe and feasible, reduces postoperative pain, facilitates early recovery, and shortens hospital stay as compared to open surgery.
As a general conclusion, it is essential to diagnose, localize, and treat paragangliomas, because of the potential cure of symptoms associated with functional tumors, prevention of a lethal hypertensive paroxysm, and early diagnosis of malignant tumors.
Laparoscopy has the advantage of optical magnification and provides better visualization of small vessels, which allows for meticulous dissection during tumor excision. Tumors located between major vessels rarely invade these vessels, but careful and meticulous dissection of the surrounding small vessels is necessary.
The laparoscopic excision of paraganglioma reduces postoperative pain, facilitates early recovery, and shortens hospital stay as compared to open surgery.
C Rodríguez-Otero Luppi, M Rodríguez Blanco, V Artigas Raventós, M Trías Folch
Surgical intervention
5 years ago
1020 views
34 likes
0 comments
12:04
Laparoscopic resection of extra-adrenal paraganglioma
Introduction
Paragangliomas are rare tumors that arise from extra-adrenal chromaffin cells. These tumors arise from dispersed paraganglia that tend to be symmetrically distributed in close relation to the aorta and to the sympathetic nervous system. Paragangliomas have a higher malignancy potential than adrenal pheochromocytomas.
Laparoscopy has the advantage of optical magnification and provides better visualization of small vessels, which allows for meticulous dissection during tumor excision. Laparoscopic resections of such tumors have been described in isolated cases.

Material and methods
We present the case of a 16-year-old female patient who presents with repeated urinary tract infection. An ultrasound demonstrates the presence of a retropancreatic mass. The study was completed by abdominal CT-scan and PET-scan (123-MIBG) where a solid mass of 4.5cm in diameter, homogeneous, encapsulated, without calcifications, located between the third duodenal portion (which is displaced anteriorly) and the inferior vena cava from the level of the right renal vein to the level of the right renal lower pole, is found. The patient presents MIBG (metaiodobenzylguanidine) tracer uptake in the Iodine-123-MIBG scintigraphy, suggesting the diagnosis of adrenal medullary tumor. The hormonal study shows a significant increase in plasmatic normetanephrine (25 times the normal upper limit). A genetic study has found no mutation of the most frequent responsible genes.
Given radiological and hormonal findings, laparoscopic surgery is decided upon with suspected diagnosis of extra-adrenal paraganglioma.

Discussion
In this video, we present a laparoscopic approach to this mass, using an 11mm optical trocar and four 5mm working trocars. As can be appreciated, a very careful dissection is carried out to separate the mass from adjacent structures, dissecting small vessels that drain directly into the inferior vena cava.
Final pathology reports a 5cm retroperitoneal paraganglioma, with vascular invasion. In the immunohistochemical study, cells are positive for Synaptophysin and Chromogranin A. The postoperative course was uneventful, and the patient was discharged on postoperative day 4.
The laparoscopic excision of paraganglioma is safe and feasible, reduces postoperative pain, facilitates early recovery, and shortens hospital stay as compared to open surgery.
As a general conclusion, it is essential to diagnose, localize, and treat paragangliomas, because of the potential cure of symptoms associated with functional tumors, prevention of a lethal hypertensive paroxysm, and early diagnosis of malignant tumors.
Laparoscopy has the advantage of optical magnification and provides better visualization of small vessels, which allows for meticulous dissection during tumor excision. Tumors located between major vessels rarely invade these vessels, but careful and meticulous dissection of the surrounding small vessels is necessary.
The laparoscopic excision of paraganglioma reduces postoperative pain, facilitates early recovery, and shortens hospital stay as compared to open surgery.
Transumbilical single access laparoscopic left adrenalectomy for symptomatic pheochromocytoma
Background: Single access laparoscopy has been reported for adrenal gland surgery. This technique can also be applied for patients presenting non-small lesions and symptomatic diseases such as pheochromocytoma.

Video: A 17-year-old woman was admitted to hospital for severe headaches, palpitations, and tachycardia along with tremulousness, dizziness, and vomiting. A symptomatic left-side single location adrenal pheochromocytoma was diagnosed and a transumbilical single access laparoscopic left adrenalectomy was proposed. The patient was placed in a semi-lateral right-sided decubitus. The technique was performed using an 11mm reusable trocar to accommodate a 10mm, 30-degree rigid and regular length scope in addition to curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tüttlingen, Germany). The procedure started with the opening of the splenocolic ligament and, after mobilization of the splenopancreatic block medially, the adrenal lesion was demonstrated. Probably due to the size of the lesion, only two main adrenal vessels were found: vein and mid-artery. Both vessels were dissected and divided between 5mm non-absorbable clips. The specimen was retrieved transumbilically in a custom-made plastic bag.

Results: Laparoscopic time was 129 minutes, estimated blood loss 20cc, and the final scar length measured 16mm. The symptomatic status of the patient was resolved immediately. The patient was discharged from the intensive care unit after 3 days and from the hospital after 6 days.

Conclusions: Transumbilical single access laparoscopic left adrenalectomy for symptomatic pheochromocytoma is feasible and safe. In young ladies, it offers an excellent cosmetic result, avoiding abdominal trauma.
G Dapri, V Zulian, M Bortes, P Mathonet, GB Cadière
Surgical intervention
5 years ago
1505 views
14 likes
0 comments
07:29
Transumbilical single access laparoscopic left adrenalectomy for symptomatic pheochromocytoma
Background: Single access laparoscopy has been reported for adrenal gland surgery. This technique can also be applied for patients presenting non-small lesions and symptomatic diseases such as pheochromocytoma.

Video: A 17-year-old woman was admitted to hospital for severe headaches, palpitations, and tachycardia along with tremulousness, dizziness, and vomiting. A symptomatic left-side single location adrenal pheochromocytoma was diagnosed and a transumbilical single access laparoscopic left adrenalectomy was proposed. The patient was placed in a semi-lateral right-sided decubitus. The technique was performed using an 11mm reusable trocar to accommodate a 10mm, 30-degree rigid and regular length scope in addition to curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tüttlingen, Germany). The procedure started with the opening of the splenocolic ligament and, after mobilization of the splenopancreatic block medially, the adrenal lesion was demonstrated. Probably due to the size of the lesion, only two main adrenal vessels were found: vein and mid-artery. Both vessels were dissected and divided between 5mm non-absorbable clips. The specimen was retrieved transumbilically in a custom-made plastic bag.

Results: Laparoscopic time was 129 minutes, estimated blood loss 20cc, and the final scar length measured 16mm. The symptomatic status of the patient was resolved immediately. The patient was discharged from the intensive care unit after 3 days and from the hospital after 6 days.

Conclusions: Transumbilical single access laparoscopic left adrenalectomy for symptomatic pheochromocytoma is feasible and safe. In young ladies, it offers an excellent cosmetic result, avoiding abdominal trauma.
Typical laparoscopic four-trocar transabdominal adrenalectomy for a 5cm right-sided pheochromocytoma
This is the case of a female patient presenting with a typical 5cm right-sided pheochromocytoma was operated on laparoscopically. Preoperative 3D MRI reconstruction allowed to precisely identify surgical landmarks. The procedure was carried out typically. Four ports were used, and dissection aimed to first mobilize the liver. Control of the main adrenal vein was achieved as the first operative step. Medial, superior, and inferior arteries were dissected and controlled successively. Total freeing of the gland was performed with no manipulation or effraction of the gland's capsule. The postoperative course was uneventful. Small-sized pheochromocytomas are excellent indications for a laparoscopic approach with early control of the vein.
D Mutter, M Vix, L Soler, J Marescaux
Surgical intervention
6 years ago
3319 views
79 likes
0 comments
23:50
Typical laparoscopic four-trocar transabdominal adrenalectomy for a 5cm right-sided pheochromocytoma
This is the case of a female patient presenting with a typical 5cm right-sided pheochromocytoma was operated on laparoscopically. Preoperative 3D MRI reconstruction allowed to precisely identify surgical landmarks. The procedure was carried out typically. Four ports were used, and dissection aimed to first mobilize the liver. Control of the main adrenal vein was achieved as the first operative step. Medial, superior, and inferior arteries were dissected and controlled successively. Total freeing of the gland was performed with no manipulation or effraction of the gland's capsule. The postoperative course was uneventful. Small-sized pheochromocytomas are excellent indications for a laparoscopic approach with early control of the vein.
Prevesical genetic paraganglioma and left adrenal mass: laparoscopic resection
Hereditary paraganglioma-pheochromocytoma syndromes are caused by genetic mutations, which lead to the development of multiple neuroendocrine tumors and paraganglioma tumors in the adrenal glands. We report the case of a young patient aged 13 who has been followed up routinely for a familial mutation of the SDHB gene. In this routine follow-up examination, an excessive plasma normetanephrine and norepinephrine secretion is evidenced. A genetic paraganglioma is diagnosed. Imaging studies are conducted to identify its location. A prevesical fixation is demonstrated by both the PET-scan and the MIBG scintigraphy. In this video, a laparoscopic resection of both lesions is demonstrated.
D Mutter, J Marescaux
Surgical intervention
8 years ago
1052 views
7 likes
0 comments
09:10
Prevesical genetic paraganglioma and left adrenal mass: laparoscopic resection
Hereditary paraganglioma-pheochromocytoma syndromes are caused by genetic mutations, which lead to the development of multiple neuroendocrine tumors and paraganglioma tumors in the adrenal glands. We report the case of a young patient aged 13 who has been followed up routinely for a familial mutation of the SDHB gene. In this routine follow-up examination, an excessive plasma normetanephrine and norepinephrine secretion is evidenced. A genetic paraganglioma is diagnosed. Imaging studies are conducted to identify its location. A prevesical fixation is demonstrated by both the PET-scan and the MIBG scintigraphy. In this video, a laparoscopic resection of both lesions is demonstrated.
Laparoscopic adrenalectomy for a bilateral large (10 cm) pheochromocytoma
This is a laparoscopic bilateral adrenalectomy performed for bilateral pheochromocytoma. Although the right gland was 10 cm in size, Prof. Targarona demonstrates skillfully how such a resection can be successfully performed laparoscopically if approached in a stepwise and meticulous fashion. This video is suitable for advanced laparoscopic surgeons.

Once the author identifies the inferior vena cava, he carefully carries out the dissection along its right border to expose the right adrenal vein. He then retracts the adrenal gland in an atraumatic fashion with a peanut gauze, being careful not to rupture the gland. Using gentle retraction with right-angle forceps, the author isolates the right adrenal vein. It is double-clipped then divided. This enables mobilization of the gland. The author then uses the harmonic scalpel to dissect around the gland. The tool can also be used to clip or divide the pedicles often encountered in this step. Once the gland is completely mobilized, one must still handle it with care. The author placed it in an extraction bag.
EM Targarona Soler
Surgical intervention
12 years ago
299 views
34 likes
0 comments
09:26
Laparoscopic adrenalectomy for a bilateral large (10 cm) pheochromocytoma
This is a laparoscopic bilateral adrenalectomy performed for bilateral pheochromocytoma. Although the right gland was 10 cm in size, Prof. Targarona demonstrates skillfully how such a resection can be successfully performed laparoscopically if approached in a stepwise and meticulous fashion. This video is suitable for advanced laparoscopic surgeons.

Once the author identifies the inferior vena cava, he carefully carries out the dissection along its right border to expose the right adrenal vein. He then retracts the adrenal gland in an atraumatic fashion with a peanut gauze, being careful not to rupture the gland. Using gentle retraction with right-angle forceps, the author isolates the right adrenal vein. It is double-clipped then divided. This enables mobilization of the gland. The author then uses the harmonic scalpel to dissect around the gland. The tool can also be used to clip or divide the pedicles often encountered in this step. Once the gland is completely mobilized, one must still handle it with care. The author placed it in an extraction bag.