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Fully robotically assisted transabdominal left adrenalectomy for hypercortisolism due to two left adrenal adenomas
This video demonstrates the case of a female patient who had been followed up by endocrinologists for 6 years. The size of the left adrenal gland had increased and two nodules of 2.5cm were found. Serum chemistries showed a progressive increase in cortisol secretion with a pathological dexamethasone suppression test (DST). Mineralocorticoids and catecholamines were normal. Noriodocholesterol scintigraphy showed an exclusive fixation of the left adrenal gland. Surgery was indicated due to the hypersecretion of the left adrenal gland.
We now have a surgical robot (da Vinci Xi™ robotic surgical system, Intuitive Surgical) and we use it for most of the adrenalectomies we perform. It provides great stability of the operative field. The precise dissection is facilitated by the dexterity of the articulated instruments.
M Vix, B Seeliger, D Mutter, J Marescaux
Surgical intervention
7 months ago
425 views
3 likes
0 comments
13:06
Fully robotically assisted transabdominal left adrenalectomy for hypercortisolism due to two left adrenal adenomas
This video demonstrates the case of a female patient who had been followed up by endocrinologists for 6 years. The size of the left adrenal gland had increased and two nodules of 2.5cm were found. Serum chemistries showed a progressive increase in cortisol secretion with a pathological dexamethasone suppression test (DST). Mineralocorticoids and catecholamines were normal. Noriodocholesterol scintigraphy showed an exclusive fixation of the left adrenal gland. Surgery was indicated due to the hypersecretion of the left adrenal gland.
We now have a surgical robot (da Vinci Xi™ robotic surgical system, Intuitive Surgical) and we use it for most of the adrenalectomies we perform. It provides great stability of the operative field. The precise dissection is facilitated by the dexterity of the articulated instruments.
LIVE INTERACTIVE SURGERY: laparoscopic left adrenalectomy for pheochromocytoma
Laparoscopic adrenalectomy was first described by Gagner et al. in 1992. It has become the procedure of choice for most benign adrenal lesions since then because of decreased blood loss, shorter hospital stay, faster recovery, and lower morbidity as compared to open surgery.
The indications for laparoscopic adrenalectomy are the same as for open surgery, except in cases of confirmed adrenocortical carcinomas.
Absolute contraindications for laparoscopic adrenalectomy are as follows: severe cardiopulmonary disease, locally advanced tumors, medically untreated pheochromocytoma, and uncontrolled coagulopathies. This is a live demonstration of a left adrenalectomy recorded during the Minimally Invasive Endocrine Surgery Course, which was held at IRCAD in May 2016.
D Mutter, P Donepudi, J Marescaux
Surgical intervention
3 years ago
4081 views
335 likes
0 comments
28:17
LIVE INTERACTIVE SURGERY: laparoscopic left adrenalectomy for pheochromocytoma
Laparoscopic adrenalectomy was first described by Gagner et al. in 1992. It has become the procedure of choice for most benign adrenal lesions since then because of decreased blood loss, shorter hospital stay, faster recovery, and lower morbidity as compared to open surgery.
The indications for laparoscopic adrenalectomy are the same as for open surgery, except in cases of confirmed adrenocortical carcinomas.
Absolute contraindications for laparoscopic adrenalectomy are as follows: severe cardiopulmonary disease, locally advanced tumors, medically untreated pheochromocytoma, and uncontrolled coagulopathies. This is a live demonstration of a left adrenalectomy recorded during the Minimally Invasive Endocrine Surgery Course, which was held at IRCAD in May 2016.
LIVE INTERACTIVE SURGERY: laparoscopic left adrenalectomy: retroperitoneal access
Retroperitoneal adrenalectomy (posterior approach) provides a direct access to the adrenal gland, hence preventing the risk of injury to intraperitoneal organs. The retroperitoneoscopic approach shortens the mean operative time and it is critical in cases of pheochromocytoma. Consequently, it is the recommended treatment for pheochromocytoma. Blood loss and the convalescence period are also shortened with this approach. The surgical principles of retroperitoneal adrenalectomy according to Professor Martin Walz are as follows: ‘en bloc’ resection, start of dissection with the upper pole of kidney, lower pole of the adrenal gland next, control of the main adrenal vein without clips, and morcellation of the gland if necessary in a bag.
M Walz, P Donepudi, L Soler, B Seeliger
Surgical intervention
3 years ago
2122 views
182 likes
0 comments
39:46
LIVE INTERACTIVE SURGERY: laparoscopic left adrenalectomy: retroperitoneal access
Retroperitoneal adrenalectomy (posterior approach) provides a direct access to the adrenal gland, hence preventing the risk of injury to intraperitoneal organs. The retroperitoneoscopic approach shortens the mean operative time and it is critical in cases of pheochromocytoma. Consequently, it is the recommended treatment for pheochromocytoma. Blood loss and the convalescence period are also shortened with this approach. The surgical principles of retroperitoneal adrenalectomy according to Professor Martin Walz are as follows: ‘en bloc’ resection, start of dissection with the upper pole of kidney, lower pole of the adrenal gland next, control of the main adrenal vein without clips, and morcellation of the gland if necessary in a bag.
Robotic left adrenalectomy for Conn's syndrome
Introduction: Since the first robotic adrenalectomy by Piazza et al. in 1999, using both the ZEUS and AESOP systems, numerous series and case reports have been published describing both left and right adrenalectomies using both transperitoneal and retroperitoneal approaches. These studies demonstrate that the robotic approach is feasible and safe.
Methods: This is the case of a 43-year-old female patient who presented with weakness, muscular cramps and systemic arterial hypertension. Her blood tests revealed a high Na++, low K+, very low renin (inhibited) and high aldosterone dose levels. A CT-scan showed a unique adenoma within 2.6cm at the left adrenal gland. She was diagnosed with Conn’s syndrome.
Results: In this video showing a robotic left adrenalectomy, the patient was placed in a left lateral decubitus, jack-knife position. Four robotic arms were used. Dissection was performed by means of scissors and of a bipolar fenestrated forceps. Operative time took 95 minutes. No measurable bleeding was observed. No UCI stay was necessary and the patient was discharged 24 hours after the intervention.
Conclusion: In this case, adrenal surgery was performed using a robotic approach, which demonstrated that the procedure was feasible, safe, with a low morbidity and a short hospital stay.
Fe Madureira, Fa Madureira, E Parra-Davila, D Madureira
Surgical intervention
4 years ago
1723 views
63 likes
0 comments
08:20
Robotic left adrenalectomy for Conn's syndrome
Introduction: Since the first robotic adrenalectomy by Piazza et al. in 1999, using both the ZEUS and AESOP systems, numerous series and case reports have been published describing both left and right adrenalectomies using both transperitoneal and retroperitoneal approaches. These studies demonstrate that the robotic approach is feasible and safe.
Methods: This is the case of a 43-year-old female patient who presented with weakness, muscular cramps and systemic arterial hypertension. Her blood tests revealed a high Na++, low K+, very low renin (inhibited) and high aldosterone dose levels. A CT-scan showed a unique adenoma within 2.6cm at the left adrenal gland. She was diagnosed with Conn’s syndrome.
Results: In this video showing a robotic left adrenalectomy, the patient was placed in a left lateral decubitus, jack-knife position. Four robotic arms were used. Dissection was performed by means of scissors and of a bipolar fenestrated forceps. Operative time took 95 minutes. No measurable bleeding was observed. No UCI stay was necessary and the patient was discharged 24 hours after the intervention.
Conclusion: In this case, adrenal surgery was performed using a robotic approach, which demonstrated that the procedure was feasible, safe, with a low morbidity and a short hospital stay.
Laparoscopic left adrenalectomy for incidentally detected large adrenal mass
We report the typical case of a young woman presenting with an incidentally detected large left adrenal mass. This was a non-functional tumor incidentally detected during ultrasound scan for other reason. CT-scan confirmed a large adrenal mass with diffuse contrast-enhancement. Blood tests for adrenal function were negative.
A laparoscopic left adrenalectomy was proposed with the main objective to perform a complete left adrenalectomy since the malignant nature of the mass cannot be excluded by available imaging studies. For laparoscopic left adrenalectomy, the patient is in a typical right lateral position. The optical trocar is in the left subcostal position. A 10mm trocar is introduced into the anterior axillary line while other 5 or 10mm trocars are placed laterally under the costal margin.
For the surgical resection of this large tumor, dissection started with the opening of the retroperitoneal space, and with the mobilization of the spleen and tail of pancreas. The renal vein is the secondary key point of dissection, allowing to identify the main adrenal vein. At this point, dissection is continued on the right side of the gland in order to identify the left adrenal artery, up to the inferior phrenic vein, and to the superior adrenal artery. The mass is cleared and removed through the extraction bag.
Editorial note: Luigi Mearini et al. have reported a left adrenalectomy exactly reproducing anatomical and technical principles as detailed on WebSurg.com. This confirms that the technique can be reproduced easily.
L Mearini, E Nunzi
Surgical intervention
5 years ago
4870 views
115 likes
0 comments
13:26
Laparoscopic left adrenalectomy for incidentally detected large adrenal mass
We report the typical case of a young woman presenting with an incidentally detected large left adrenal mass. This was a non-functional tumor incidentally detected during ultrasound scan for other reason. CT-scan confirmed a large adrenal mass with diffuse contrast-enhancement. Blood tests for adrenal function were negative.
A laparoscopic left adrenalectomy was proposed with the main objective to perform a complete left adrenalectomy since the malignant nature of the mass cannot be excluded by available imaging studies. For laparoscopic left adrenalectomy, the patient is in a typical right lateral position. The optical trocar is in the left subcostal position. A 10mm trocar is introduced into the anterior axillary line while other 5 or 10mm trocars are placed laterally under the costal margin.
For the surgical resection of this large tumor, dissection started with the opening of the retroperitoneal space, and with the mobilization of the spleen and tail of pancreas. The renal vein is the secondary key point of dissection, allowing to identify the main adrenal vein. At this point, dissection is continued on the right side of the gland in order to identify the left adrenal artery, up to the inferior phrenic vein, and to the superior adrenal artery. The mass is cleared and removed through the extraction bag.
Editorial note: Luigi Mearini et al. have reported a left adrenalectomy exactly reproducing anatomical and technical principles as detailed on WebSurg.com. This confirms that the technique can be reproduced easily.
Posterior approach to laparoscopic left adrenalectomy including virtual reality simulation
Since M. Gagner published the first case of a transperitoneal laparoscopic adrenalectomy in 1992, the laparoscopic adrenalectomy has gradually become the standard operation for removing adrenal tumors. Compared to a traditional adrenalectomy, a laparoscopic adrenalectomy has a number of advantages, including less blood loss, a shorter hospital stay, a quicker recovery, and fewer complications. There are many ways to approach the adrenal gland laparoscopically, such as by a lateral transperitoneal approach, anterior transperitoneal approach, lateral retroperitoneal approach, and posterior retroperitoneal approach. This video shows a posterior left adrenalectomy using virtual reality simulation.
M Walz, L Soler, J Marescaux
Surgical intervention
7 years ago
1925 views
30 likes
0 comments
25:24
Posterior approach to laparoscopic left adrenalectomy including virtual reality simulation
Since M. Gagner published the first case of a transperitoneal laparoscopic adrenalectomy in 1992, the laparoscopic adrenalectomy has gradually become the standard operation for removing adrenal tumors. Compared to a traditional adrenalectomy, a laparoscopic adrenalectomy has a number of advantages, including less blood loss, a shorter hospital stay, a quicker recovery, and fewer complications. There are many ways to approach the adrenal gland laparoscopically, such as by a lateral transperitoneal approach, anterior transperitoneal approach, lateral retroperitoneal approach, and posterior retroperitoneal approach. This video shows a posterior left adrenalectomy using virtual reality simulation.
Laparoscopic left adrenalectomy for Conn's adenoma: three trocar technique
Conn's disease is a condition in which the adrenal glands produce too much aldosterone. Prevalence estimates for Conn's syndrome is about 0.03-1.2% of the population with hypertension.
Many patients with Conn's disease have a high blood pressure that is difficult to control. This increases the risk of stroke, heart disease and kidney failure. When Conn's disease is caused by a tumor (benign adrenal adenoma), surgical resection is advised. This video demonstrates the case of a woman presenting with Conn’s disease. The preoperative work-up demonstrated a tumor located on the left adrenal gland. The patient presented an elevated aldosteronemia and the CT-scan demonstrated a 2cm left adrenal tumor. The patient is placed in a full lateral position, on the right side.
D Mutter, L Soler, J Marescaux
Surgical intervention
10 years ago
1655 views
110 likes
0 comments
15:51
Laparoscopic left adrenalectomy for Conn's adenoma: three trocar technique
Conn's disease is a condition in which the adrenal glands produce too much aldosterone. Prevalence estimates for Conn's syndrome is about 0.03-1.2% of the population with hypertension.
Many patients with Conn's disease have a high blood pressure that is difficult to control. This increases the risk of stroke, heart disease and kidney failure. When Conn's disease is caused by a tumor (benign adrenal adenoma), surgical resection is advised. This video demonstrates the case of a woman presenting with Conn’s disease. The preoperative work-up demonstrated a tumor located on the left adrenal gland. The patient presented an elevated aldosteronemia and the CT-scan demonstrated a 2cm left adrenal tumor. The patient is placed in a full lateral position, on the right side.
Laparoscopic left adrenalectomy for Conn's disease: virtual reality and exposure for vascular approach
This is a very detailed and didactic video demonstrating laparoscopic left adrenalectomy. All the critical steps are presented clearly and the surgical approach is explained at each stage. All the dissection is performed with only a hook cautery and atraumatic graspers. This is an excellent video for laparoscopic surgeons interested in learning adrenalectomy.

Key landmarks in this step are the splenic, adrenal, and renal veins—and the three main arterial pedicles of the latter that supply the left adrenal gland. The steady mobilization of the pancreas with retraction to the left with the spleen allows the authors to identify the renal vein, clear identification of which is essential. Steady dissection of the superior border of the renal vein enables positive identification of the adrenal vein. The authors dissect it circumferentially from the superior border of the renal vein up to the origin of the phrenic vein.
D Mutter, J Marescaux, L Soler
Surgical intervention
12 years ago
3214 views
67 likes
0 comments
14:22
Laparoscopic left adrenalectomy for Conn's disease: virtual reality and exposure for vascular approach
This is a very detailed and didactic video demonstrating laparoscopic left adrenalectomy. All the critical steps are presented clearly and the surgical approach is explained at each stage. All the dissection is performed with only a hook cautery and atraumatic graspers. This is an excellent video for laparoscopic surgeons interested in learning adrenalectomy.

Key landmarks in this step are the splenic, adrenal, and renal veins—and the three main arterial pedicles of the latter that supply the left adrenal gland. The steady mobilization of the pancreas with retraction to the left with the spleen allows the authors to identify the renal vein, clear identification of which is essential. Steady dissection of the superior border of the renal vein enables positive identification of the adrenal vein. The authors dissect it circumferentially from the superior border of the renal vein up to the origin of the phrenic vein.