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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
6 months ago
341 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.
Minimally invasive right superior parathyroidectomy (MIVAP) for symptomatic primary hyperparathyroidism
This video presents the case of a 62 year-old patient with primary hyperparathyroidism characterized by a PTH which is inconsistent with calcium levels. The diagnosis is confirmed by biological findings before searching for the adenoma inducing this hypersecretion. With the use of current precision imaging techniques, in most cases, the adenoma can be identified and managed surgically. In our team, we perform a 99m Tc-MIBI scintigraphy and a CT-scan allowing for a 3D reconstruction according to the IRCAD protocol. This 3D reconstruction shows the relationships between the adenoma, the inferior thyroid artery, the thyroid gland, and the esophagus, making it possible to perform a video-assisted approach using a scar inferior to 2cm.
M Vix, HA Mercoli, S Tzedakis, J Marescaux
Surgical intervention
2 years ago
1040 views
118 likes
0 comments
08:28
Minimally invasive right superior parathyroidectomy (MIVAP) for symptomatic primary hyperparathyroidism
This video presents the case of a 62 year-old patient with primary hyperparathyroidism characterized by a PTH which is inconsistent with calcium levels. The diagnosis is confirmed by biological findings before searching for the adenoma inducing this hypersecretion. With the use of current precision imaging techniques, in most cases, the adenoma can be identified and managed surgically. In our team, we perform a 99m Tc-MIBI scintigraphy and a CT-scan allowing for a 3D reconstruction according to the IRCAD protocol. This 3D reconstruction shows the relationships between the adenoma, the inferior thyroid artery, the thyroid gland, and the esophagus, making it possible to perform a video-assisted approach using a scar inferior to 2cm.
Video-assisted exploration of the four parathyroid lobes for primary hyperparathyroidism
Background:
The presence of a single parathyroid adenoma accurately located using preoperative imaging is the best indication for minimally invasive surgery when dealing with primary hyperparathyroidism. It is certainly possible to search for several glands that may be suspicious of adenoma, but an extensive experience in video-assisted cervical surgery is required to find the anatomical structures allowing to explore the four parathyroid locations.
Patient and methods:
A 75-year-old obese woman is diagnosed with hypercalcemia, hypophosphoremia, and a high level of PTH during a work-up for joint pain.

Preoperative imaging includes a 3D-reconstructed cervico-mediastinal CT-scan —a computer program developed at the IRCAD-Strasbourg, named VrAnat™, Vr planning™, is used for that purpose. This 3D virtual reconstruction demonstrates three suspicious images respectively located at the right superior parathyroid territory, at the right latero-esophageal area, and at the left inferior parathyroid territory. A video-assisted cervical exploration, guided by this reconstruction, is decided upon. The objective is to find the three suspicious images and to explore the four parathyroid glands.

A 3cm median incision is carried out 2cm above the sternal notch. The right thyrotracheal groove is reached through a dissection performed laterally to the strap muscles and medially to the omohyoid muscle. A complete dissection of the lateral aspect of the thyroid lobe is obtained using blunt dissection and small instruments under endoscopic vision, which is provided by a 30-degree, 5mm scope (Storz, Tüttlingen, Germany). The recurrent laryngeal nerve is identified.

Dissection is now carried on above the inferior thyroid artery. It allows to rapidly identify a superior parathyroid adenoma, which will be resected. It exactly matches with one of the suspicious images.

Dissection is pursued anterior to the intersection between the artery and the nerve so as to find the right inferior parathyroid, which is healthy, underneath the capsule. The latero-esophageal image is now searched for. It is nothing but an anthracosic lymph node.

The left side is approached by dissecting the left jugulocarotid gutter. The left recurrent nerve is identified. The left inferior parathyroid is identified and looks healthy. The suspected image is nothing else but a nodule of the apex of the thyrothymic ligament. The left superior parathyroid, which is healthy, can be finally identified in a strictly orthotopic position, although partially hidden behind a Zuckerkandl’s nodule.

Conclusion:
This cervical exploration has led to the dissection and visualization of the four parathyroid lobes in compliance with classical parathyroid surgery principles.
References:
Berti P, Materazzi G, Picone A, Miccoli P. Limits and drawbacks of video-assisted parathyroidectomy. Br J Surg 2003;90:743-7.

Miccoli P, Materazzi G, Baggiani A, Miccoli M. Mini-invasive video-assisted surgery of the thyroid and parathyroid glands: a 2011 update. J Endocrinol Invest 2011;34:473-80.
M Vix, D Mutter, J Marescaux
Surgical intervention
2 years ago
543 views
71 likes
0 comments
09:39
Video-assisted exploration of the four parathyroid lobes for primary hyperparathyroidism
Background:
The presence of a single parathyroid adenoma accurately located using preoperative imaging is the best indication for minimally invasive surgery when dealing with primary hyperparathyroidism. It is certainly possible to search for several glands that may be suspicious of adenoma, but an extensive experience in video-assisted cervical surgery is required to find the anatomical structures allowing to explore the four parathyroid locations.
Patient and methods:
A 75-year-old obese woman is diagnosed with hypercalcemia, hypophosphoremia, and a high level of PTH during a work-up for joint pain.

Preoperative imaging includes a 3D-reconstructed cervico-mediastinal CT-scan —a computer program developed at the IRCAD-Strasbourg, named VrAnat™, Vr planning™, is used for that purpose. This 3D virtual reconstruction demonstrates three suspicious images respectively located at the right superior parathyroid territory, at the right latero-esophageal area, and at the left inferior parathyroid territory. A video-assisted cervical exploration, guided by this reconstruction, is decided upon. The objective is to find the three suspicious images and to explore the four parathyroid glands.

A 3cm median incision is carried out 2cm above the sternal notch. The right thyrotracheal groove is reached through a dissection performed laterally to the strap muscles and medially to the omohyoid muscle. A complete dissection of the lateral aspect of the thyroid lobe is obtained using blunt dissection and small instruments under endoscopic vision, which is provided by a 30-degree, 5mm scope (Storz, Tüttlingen, Germany). The recurrent laryngeal nerve is identified.

Dissection is now carried on above the inferior thyroid artery. It allows to rapidly identify a superior parathyroid adenoma, which will be resected. It exactly matches with one of the suspicious images.

Dissection is pursued anterior to the intersection between the artery and the nerve so as to find the right inferior parathyroid, which is healthy, underneath the capsule. The latero-esophageal image is now searched for. It is nothing but an anthracosic lymph node.

The left side is approached by dissecting the left jugulocarotid gutter. The left recurrent nerve is identified. The left inferior parathyroid is identified and looks healthy. The suspected image is nothing else but a nodule of the apex of the thyrothymic ligament. The left superior parathyroid, which is healthy, can be finally identified in a strictly orthotopic position, although partially hidden behind a Zuckerkandl’s nodule.

Conclusion:
This cervical exploration has led to the dissection and visualization of the four parathyroid lobes in compliance with classical parathyroid surgery principles.
References:
Berti P, Materazzi G, Picone A, Miccoli P. Limits and drawbacks of video-assisted parathyroidectomy. Br J Surg 2003;90:743-7.

Miccoli P, Materazzi G, Baggiani A, Miccoli M. Mini-invasive video-assisted surgery of the thyroid and parathyroid glands: a 2011 update. J Endocrinol Invest 2011;34:473-80.
PerOral Endoscopic Thyroidectomy (POET), a novel pioneering technique
Thyroid surgery has evolved towards minimally invasive approaches to reduce or prevent cervical scars, which are potential seats for keloidal scarring. Several approaches have been put forward: video-assisted surgery via a reduced cervical scar, transaxillary access with or without robotic assistance, transoral retromandibular approach, retroauricular approach in keeping with a lifting procedure.
In this video, we present the case of an original transoral vestibular approach. This access is exclusively subcutaneous. No cervical scar is necessary. This technique allows for a unilateral or bilateral approach in excellent visualization conditions. Dissection is performed from cranially to caudally with the rapid identification of the inferior laryngeal nerve.
A Anuwong, M Vix, HS Wu
Surgical intervention
2 years ago
4528 views
315 likes
1 comment
25:34
PerOral Endoscopic Thyroidectomy (POET), a novel pioneering technique
Thyroid surgery has evolved towards minimally invasive approaches to reduce or prevent cervical scars, which are potential seats for keloidal scarring. Several approaches have been put forward: video-assisted surgery via a reduced cervical scar, transaxillary access with or without robotic assistance, transoral retromandibular approach, retroauricular approach in keeping with a lifting procedure.
In this video, we present the case of an original transoral vestibular approach. This access is exclusively subcutaneous. No cervical scar is necessary. This technique allows for a unilateral or bilateral approach in excellent visualization conditions. Dissection is performed from cranially to caudally with the rapid identification of the inferior laryngeal nerve.
Totally endoscopic left hemithyroidectomy: axillary approach for papillary carcinoma, including a critical analysis by M Vix, MD, and point by point answer by Dr. Shah
Introduction:
Endoscopic thyroidectomy is a novel approach used to avoid cervical scar, which represents sequelae of conventional thyroidectomies. This technique is feasible providing equal results under expert hands.
Case presentation:
This is the case of a 20 year-old woman with cervical swelling, a 3 by 3cm solitary nodule in the left thyroid lobe, which was evaluated clinically, radiologically, and withfine-needle aspiration cytology (FNAC). She was diagnosed with a low-risk papillary carcinoma.
Discussion:
The patient underwent an endoscopic transaxillary left hemithyroidectomy under general anesthesia. The recurrent laryngeal nerve and the parathyroid gland were preserved. The patient was discharged with a normal tone on postoperative day 1.
Conclusion:
Endoscopic transaxillary thyroidectomy is a feasible good technique with equal results, which can be considered for patients with small thyroid lesions. Conventional laparoscopic instruments are used without the need for extra instrumentation.

This video is commented upon by Dr. M Vix, MD (University Hospital, Strasbourg, France), providing a comprehensive outline of Dr. Shah's original technique.


Point by point answer by Dr. Shah:

1. Carbon dioxide causing surgical emphysema, especially of an incapacitating nature, has not been experienced since intracavitary pressures are generally maintained at a low level by the almost continuous low-grade suction used throughout the surgery.

2. In our experience, adequate visualization of the thyroid pedicles in close proximity to the gland precludes the need for a deeper and more lateral dissection to identify the jugulocarotid vessels. This potentially decreases the risk of a major vascular mishap.

3. As is the norm with open thyroidectomy, division of the superior thyroid pedicle close to the gland usually does not require the identification of the superior laryngeal nerve.

4. In this approach, the recurrent laryngeal nerve is identified very early on in the dissection. Subsequent dissection is performed in a plane anterior to the visualized nerve, hence preventing any injuries. The recurrent laryngeal nerve is visualized in its entire extent up to Berry's ligament.



AR Shah
Surgical intervention
2 years ago
1014 views
114 likes
0 comments
11:09
Totally endoscopic left hemithyroidectomy: axillary approach for papillary carcinoma, including a critical analysis by M Vix, MD, and point by point answer by Dr. Shah
Introduction:
Endoscopic thyroidectomy is a novel approach used to avoid cervical scar, which represents sequelae of conventional thyroidectomies. This technique is feasible providing equal results under expert hands.
Case presentation:
This is the case of a 20 year-old woman with cervical swelling, a 3 by 3cm solitary nodule in the left thyroid lobe, which was evaluated clinically, radiologically, and withfine-needle aspiration cytology (FNAC). She was diagnosed with a low-risk papillary carcinoma.
Discussion:
The patient underwent an endoscopic transaxillary left hemithyroidectomy under general anesthesia. The recurrent laryngeal nerve and the parathyroid gland were preserved. The patient was discharged with a normal tone on postoperative day 1.
Conclusion:
Endoscopic transaxillary thyroidectomy is a feasible good technique with equal results, which can be considered for patients with small thyroid lesions. Conventional laparoscopic instruments are used without the need for extra instrumentation.

This video is commented upon by Dr. M Vix, MD (University Hospital, Strasbourg, France), providing a comprehensive outline of Dr. Shah's original technique.


Point by point answer by Dr. Shah:

1. Carbon dioxide causing surgical emphysema, especially of an incapacitating nature, has not been experienced since intracavitary pressures are generally maintained at a low level by the almost continuous low-grade suction used throughout the surgery.

2. In our experience, adequate visualization of the thyroid pedicles in close proximity to the gland precludes the need for a deeper and more lateral dissection to identify the jugulocarotid vessels. This potentially decreases the risk of a major vascular mishap.

3. As is the norm with open thyroidectomy, division of the superior thyroid pedicle close to the gland usually does not require the identification of the superior laryngeal nerve.

4. In this approach, the recurrent laryngeal nerve is identified very early on in the dissection. Subsequent dissection is performed in a plane anterior to the visualized nerve, hence preventing any injuries. The recurrent laryngeal nerve is visualized in its entire extent up to Berry's ligament.



Ethics and new technology: are we being honest with our patients?
Dr. Angelos delivers an amazing lecture on the following issue: “Ethics and new technology”. He briefly describes progress in the field of surgery and the ethics of innovation. He also outlines the basics of professionalism in medicine, surgeon-patient relationship, and informed consent for innovative operations. He describes the main principles to assess the potential benefits of innovative techniques via the surgeon’s participation in clinical trials or registries. He emphasizes the management of ethical issues via discussions between individual surgeons and patients about the uncertainties of innovations in order to make informed consent a reality.
P Angelos
Lecture
2 years ago
209 views
15 likes
0 comments
22:04
Ethics and new technology: are we being honest with our patients?
Dr. Angelos delivers an amazing lecture on the following issue: “Ethics and new technology”. He briefly describes progress in the field of surgery and the ethics of innovation. He also outlines the basics of professionalism in medicine, surgeon-patient relationship, and informed consent for innovative operations. He describes the main principles to assess the potential benefits of innovative techniques via the surgeon’s participation in clinical trials or registries. He emphasizes the management of ethical issues via discussions between individual surgeons and patients about the uncertainties of innovations in order to make informed consent a reality.
Is minimally invasive thyroidectomy and parathyroidectomy a real progress?
In this video, Dr. QY Duh briefly describes the main principles of MIVAT and MIVAP and compares the novel techniques used for minimal incision thyroidectomy. He presents the advantages, disadvantages and complications of MIVAP & MIVAT, and outlines current innovative approaches for transaxillary thyroidectomy, e.g. robot-assisted BABA, RATS, facelift thyroidectomy, eMIT, TOVAT, TOVANS, and TOETVA. He demonstrates the key steps in the evolution of MIS thyroidectomy from Kocher, mini-incision, MIVAT, extracervical access to NOTES with main advantages of safety –short incision and no neck incision. Finally, he stresses that minimally invasive thyroid surgery is a real progress to evaluate new operations based on safety and efficacy. However, it may not be a real progress in terms of cost and mortality or morbidity.
QY Duh
Lecture
2 years ago
294 views
21 likes
0 comments
19:41
Is minimally invasive thyroidectomy and parathyroidectomy a real progress?
In this video, Dr. QY Duh briefly describes the main principles of MIVAT and MIVAP and compares the novel techniques used for minimal incision thyroidectomy. He presents the advantages, disadvantages and complications of MIVAP & MIVAT, and outlines current innovative approaches for transaxillary thyroidectomy, e.g. robot-assisted BABA, RATS, facelift thyroidectomy, eMIT, TOVAT, TOVANS, and TOETVA. He demonstrates the key steps in the evolution of MIS thyroidectomy from Kocher, mini-incision, MIVAT, extracervical access to NOTES with main advantages of safety –short incision and no neck incision. Finally, he stresses that minimally invasive thyroid surgery is a real progress to evaluate new operations based on safety and efficacy. However, it may not be a real progress in terms of cost and mortality or morbidity.
Is robotic thyroid surgery a real progress?
In this key lecture, Prof. WY Chung briefly describes his experience and his own technique to perform robotic thyroid surgery. He presents advances in surgical indications and compares the main differences of single incision robotic thyroidectomy and LND with novel techniques, e.g. BABA, facelift thyroidectomy, and transoral periosteal thyroidectomy. He demonstrates the advantages and limitations using research data to describe the future of robotic thyroidectomy as a minimally invasive surgery. He highlights new technologies and newly developed robotic systems with current improvements, which focus on haptic feedback, tactile sensation, and single orifice surgery, which will make AI robotic automation surgery possible in the future.
WY Chung
Lecture
2 years ago
402 views
50 likes
0 comments
13:32
Is robotic thyroid surgery a real progress?
In this key lecture, Prof. WY Chung briefly describes his experience and his own technique to perform robotic thyroid surgery. He presents advances in surgical indications and compares the main differences of single incision robotic thyroidectomy and LND with novel techniques, e.g. BABA, facelift thyroidectomy, and transoral periosteal thyroidectomy. He demonstrates the advantages and limitations using research data to describe the future of robotic thyroidectomy as a minimally invasive surgery. He highlights new technologies and newly developed robotic systems with current improvements, which focus on haptic feedback, tactile sensation, and single orifice surgery, which will make AI robotic automation surgery possible in the future.
Transoral endoscopic thyroidectomy: vestibular approach
In this state-of-the-art lecture, Dr. Anuwong briefly describes the historical developments of thyroidectomy with various approaches, emphasizing natural orifice thyroid surgery with an overview of the first report in animal models, cadaveric models, and human patients in different countries as it happened over time. He describes the key steps, main principles, and complications of TOVANS, ETOA, and TOPOT with their drawbacks. He also introduces his technique of transoral endoscopic thyroidectomy: vestibular approach (TOETVA) with the brief concept of mental nerve injury. He demonstrates his experience in a case report of right lobectomy using TOETVA with postoperative management and impressive results achieved with no infection and no scar. The TOETVA technique proves to be promising as it is safe, feasible, comparable to other approaches, and has excellent cosmetic results.
A Anuwong
Lecture
2 years ago
1720 views
130 likes
0 comments
28:41
Transoral endoscopic thyroidectomy: vestibular approach
In this state-of-the-art lecture, Dr. Anuwong briefly describes the historical developments of thyroidectomy with various approaches, emphasizing natural orifice thyroid surgery with an overview of the first report in animal models, cadaveric models, and human patients in different countries as it happened over time. He describes the key steps, main principles, and complications of TOVANS, ETOA, and TOPOT with their drawbacks. He also introduces his technique of transoral endoscopic thyroidectomy: vestibular approach (TOETVA) with the brief concept of mental nerve injury. He demonstrates his experience in a case report of right lobectomy using TOETVA with postoperative management and impressive results achieved with no infection and no scar. The TOETVA technique proves to be promising as it is safe, feasible, comparable to other approaches, and has excellent cosmetic results.
Laparoscopic excision of a celiac paraganglioma
A 72-year-old woman was addressed to the endocrinologist for arterial hypertension and US finding of a 5cm nodule in the aortocaval space of the celiac region. The diagnostic workup revealed raised urinary metanephrines. A CT-scan confirmed the US findings, and the nodule was also positive at PET CT-scan. A fine needle biopsy was performed, which was suggestive of a paraganglioma.
Medical treatment with Doxazosine 44mg qd was required for the adequate control of hypertension, and surgical excision was required.
A laparoscopic lateral transabdominal approach was chosen, to displace the hepatoduodenal ligament and allow for a wide access to the inferior vena cava. The operative time was 75 minutes. The patient recovered with no complications and was discharged on postoperative day 3.
Her symptoms recovered and she was found with normal metanephrines at follow-up.
M Lotti, M Giulii Capponi, L Ansaloni
Surgical intervention
2 years ago
995 views
57 likes
0 comments
08:21
Laparoscopic excision of a celiac paraganglioma
A 72-year-old woman was addressed to the endocrinologist for arterial hypertension and US finding of a 5cm nodule in the aortocaval space of the celiac region. The diagnostic workup revealed raised urinary metanephrines. A CT-scan confirmed the US findings, and the nodule was also positive at PET CT-scan. A fine needle biopsy was performed, which was suggestive of a paraganglioma.
Medical treatment with Doxazosine 44mg qd was required for the adequate control of hypertension, and surgical excision was required.
A laparoscopic lateral transabdominal approach was chosen, to displace the hepatoduodenal ligament and allow for a wide access to the inferior vena cava. The operative time was 75 minutes. The patient recovered with no complications and was discharged on postoperative day 3.
Her symptoms recovered and she was found with normal metanephrines at follow-up.
Robotic adrenalectomy for left adrenal Conn’s adenoma: live broadcast
According to recent studies, robotic adrenalectomy has proven to be superior to laparoscopic adrenalectomy, with a reduction of blood loss during procedure and a reduced operative time.
The robotic system provides an intraoperative stability to the surgeon, allowing for a perfect handling of sensitive functional adrenal tumors. The main advantage of robotics lies in the ease of dissection, aided by improved visualization, the EndoWrist®, articulated instruments, and reduction of tremors, allowing for more accurate movements.

Indications: hormone-secreting tumors, adrenal masses >5cm, smaller lesions suspicious for malignancy, and lesions increasing in size on serial imaging.
Contraindications: infiltrative adrenal masses and tumors of extremely large size, because the size of adrenal lesions correlates with the potential for adrenal carcinoma.
The da Vinci Robotic Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) and the following robotic instruments are used:30-degree scope, ProGrasp™ forceps, Hot Shears (monopolar curved scissors or a hook), and a Robotic Clip Applier. A monopolar cautery hook and Harmonic ACE® curved shears can also be used when deemed helpful by the surgeon.
Laparoscopic instruments that can be handled by the bedside assistant, a clip applier and a suction device are also used.
CN Tang
Surgical intervention
2 years ago
1867 views
133 likes
0 comments
24:47
Robotic adrenalectomy for left adrenal Conn’s adenoma: live broadcast
According to recent studies, robotic adrenalectomy has proven to be superior to laparoscopic adrenalectomy, with a reduction of blood loss during procedure and a reduced operative time.
The robotic system provides an intraoperative stability to the surgeon, allowing for a perfect handling of sensitive functional adrenal tumors. The main advantage of robotics lies in the ease of dissection, aided by improved visualization, the EndoWrist®, articulated instruments, and reduction of tremors, allowing for more accurate movements.

Indications: hormone-secreting tumors, adrenal masses >5cm, smaller lesions suspicious for malignancy, and lesions increasing in size on serial imaging.
Contraindications: infiltrative adrenal masses and tumors of extremely large size, because the size of adrenal lesions correlates with the potential for adrenal carcinoma.
The da Vinci Robotic Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) and the following robotic instruments are used:30-degree scope, ProGrasp™ forceps, Hot Shears (monopolar curved scissors or a hook), and a Robotic Clip Applier. A monopolar cautery hook and Harmonic ACE® curved shears can also be used when deemed helpful by the surgeon.
Laparoscopic instruments that can be handled by the bedside assistant, a clip applier and a suction device are also used.
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
3983 views
334 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
2074 views
181 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.
Laparoscopic adrenalectomy (update of September 2014 presentation)
Laparoscopic adrenalectomy is an attractive alternative to open surgery in children as it is associated with less operative pain and a rapid resumption of diet and shorter operative time.
The relative contraindications are patients with malignancies which involve lymph nodes, highly vascular pheochromocytomas, and large tumors.
Neuroblastoma, congenital adrenal hyperplasia, pheochromocytomas and adrenal cortical carcinomas are the main indications in children.
The transabdominal lateral approach is more commonly used in the pediatric population.
The tumors are incidental findings and 31% of them are malignant in children.
The various techniques of adrenalectomy, preoperative work-up, and indications are described in this lecture.
D Patkowski
Lecture
3 years ago
1430 views
89 likes
0 comments
16:05
Laparoscopic adrenalectomy (update of September 2014 presentation)
Laparoscopic adrenalectomy is an attractive alternative to open surgery in children as it is associated with less operative pain and a rapid resumption of diet and shorter operative time.
The relative contraindications are patients with malignancies which involve lymph nodes, highly vascular pheochromocytomas, and large tumors.
Neuroblastoma, congenital adrenal hyperplasia, pheochromocytomas and adrenal cortical carcinomas are the main indications in children.
The transabdominal lateral approach is more commonly used in the pediatric population.
The tumors are incidental findings and 31% of them are malignant in children.
The various techniques of adrenalectomy, preoperative work-up, and indications are described in this lecture.
Laparoscopic adrenalectomy
Retroperitoneoscopic adrenalectomy was developed in 1993, initially only for small benign lesions and recently for lesions superior to 5 cm and even malignancies.
This retroperitoneal technique has gained popularity since it allows for a direct access to the gland and prevents unexpected injuries to the intra-abdominal organs.
In this lecture, Dr. Mushtaq outlines the indications for adrenalectomy in children, patient set-up, trocar placement, and operative technique overview. The importance of resecting the gland ‘en bloc’ has been emphasized.
The retroperitoneal approach begins by placing the child in a prone position. The 12th rib, iliac crest, and paravertebral muscles are then marked on the patient. The first incision is made at the lateral border of the lateral vertebral muscles, halfway between the 12th rib and the iliac crest (Heloury et al., 2011).
This lecture was delivered during the pediatric urology course held at IRCAD in March 2016.
I Mushtaq
Lecture
3 years ago
1795 views
143 likes
0 comments
16:41
Laparoscopic adrenalectomy
Retroperitoneoscopic adrenalectomy was developed in 1993, initially only for small benign lesions and recently for lesions superior to 5 cm and even malignancies.
This retroperitoneal technique has gained popularity since it allows for a direct access to the gland and prevents unexpected injuries to the intra-abdominal organs.
In this lecture, Dr. Mushtaq outlines the indications for adrenalectomy in children, patient set-up, trocar placement, and operative technique overview. The importance of resecting the gland ‘en bloc’ has been emphasized.
The retroperitoneal approach begins by placing the child in a prone position. The 12th rib, iliac crest, and paravertebral muscles are then marked on the patient. The first incision is made at the lateral border of the lateral vertebral muscles, halfway between the 12th rib and the iliac crest (Heloury et al., 2011).
This lecture was delivered during the pediatric urology course held at IRCAD in March 2016.
Right and left adrenalectomy by transperitoneal approach
In this video, Professor Didier Mutter demonstrates different approaches for laparoscopic adrenalectomy. For a precise and fast dissection, the quality of camera and instruments is essential. Vascular landmarks are of paramount importance, Sometimes, there is a duplication of the adrenal vein, and any mistake in dissection can cause difficulty to control bleeding. 3D reconstruction helps to identify some original anatomical variations. In this lecture, Professor Mutter also discusses the robotic approach used to perform an adrenalectomy with 3D reconstruction for vascular exploration in order to prevent renal vascular damage. The laparoscopic approach is the gold standard for all types of glands. In some complicated cases, the procedure is converted to an open procedure. This does not mean that the technique has failed.
D Mutter
Lecture
2 years ago
3251 views
292 likes
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18:17
Right and left adrenalectomy by transperitoneal approach
In this video, Professor Didier Mutter demonstrates different approaches for laparoscopic adrenalectomy. For a precise and fast dissection, the quality of camera and instruments is essential. Vascular landmarks are of paramount importance, Sometimes, there is a duplication of the adrenal vein, and any mistake in dissection can cause difficulty to control bleeding. 3D reconstruction helps to identify some original anatomical variations. In this lecture, Professor Mutter also discusses the robotic approach used to perform an adrenalectomy with 3D reconstruction for vascular exploration in order to prevent renal vascular damage. The laparoscopic approach is the gold standard for all types of glands. In some complicated cases, the procedure is converted to an open procedure. This does not mean that the technique has failed.
Laparoscopic posterior retroperitoneoscopic adrenalectomy
In this video, Professor Martin Walz presents the main principles of laparoscopic retroperitoneoscopic adrenalectomy. The patient lies in a prone position with the adrenal gland being approached posteriorly beneath the 12th rib, thereby allowing for a direct access to the retroperitoneum and adrenal gland without the need for intra-abdominal organ mobilization. Carbon dioxide pressure and camera position play a key role for better exposure and imaging. High insufflation pressures in the retroperitoneal space can also reduce troublesome bleeding. This approach remains the best option with no blood loss and reduced postoperative pain, less morbidity, a shorter hospital stay, and an earlier return to normal activities.
M Walz
Lecture
2 years ago
1450 views
100 likes
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14:34
Laparoscopic posterior retroperitoneoscopic adrenalectomy
In this video, Professor Martin Walz presents the main principles of laparoscopic retroperitoneoscopic adrenalectomy. The patient lies in a prone position with the adrenal gland being approached posteriorly beneath the 12th rib, thereby allowing for a direct access to the retroperitoneum and adrenal gland without the need for intra-abdominal organ mobilization. Carbon dioxide pressure and camera position play a key role for better exposure and imaging. High insufflation pressures in the retroperitoneal space can also reduce troublesome bleeding. This approach remains the best option with no blood loss and reduced postoperative pain, less morbidity, a shorter hospital stay, and an earlier return to normal activities.
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, M Giulii Capponi, B Carrara, L Moroni, S Cassibba, D Gianola
Surgical intervention
3 years ago
839 views
40 likes
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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
3 years ago
2148 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.