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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
9 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 right adrenalectomy for Conn's adenoma using ultrasonic shears
This video very clearly displays all the salient points of the performance of a right adrenalectomy with particular emphasis on the control of the vascular supply.
After controlling the venous landmarks, the authors move to control the main arteries of the adrenal gland. The authors identify the medial and superior pedicles and completely dissect them, gaining control with a one-clip application. The medial pedicle is only 1cm from the aorta. Severe bleeding may ensue, so they control the superior pedicle originating from the diaphragmatic artery with a clip. Identifying these arteries allows the authors to perform a complete removal of the adrenal gland and its surrounding fat. They clearly identify the renal artery, the renal vein just above it, and the inferior pedicle, which is also controlled with a simple clip application. At this point, the gland can be completely mobilized medially and inferiorly.
D Mutter, J Marescaux
Surgical intervention
11 years ago
2358 views
109 likes
3 comments
07:37
Laparoscopic right adrenalectomy for Conn's adenoma using ultrasonic shears
This video very clearly displays all the salient points of the performance of a right adrenalectomy with particular emphasis on the control of the vascular supply.
After controlling the venous landmarks, the authors move to control the main arteries of the adrenal gland. The authors identify the medial and superior pedicles and completely dissect them, gaining control with a one-clip application. The medial pedicle is only 1cm from the aorta. Severe bleeding may ensue, so they control the superior pedicle originating from the diaphragmatic artery with a clip. Identifying these arteries allows the authors to perform a complete removal of the adrenal gland and its surrounding fat. They clearly identify the renal artery, the renal vein just above it, and the inferior pedicle, which is also controlled with a simple clip application. At this point, the gland can be completely mobilized medially and inferiorly.
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
3228 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.
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
304 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.