PMC3085471_01
Preoperative CT scans and postoperative specimens of Cases 1 and 2, who underwent left adrenalectomy with combined technique using LESS with an additional accessory port.
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Her 24-h urine catecholamine levels were slightly elevated, and CT scan revealed a 23-mm left adrenal mass (Figure 1).
PMC3085471_02
Preoperative CT scans and postoperative specimens of Cases 1 and 2, who underwent left adrenalectomy with combined technique using LESS with an additional accessory port.
CRIM2011-651380.001.jpg
PMC3085471_02_CRIM2011-651380.001.jpg
fig1
Her 24-h urine catecholamine levels were slightly elevated, and CT scan revealed a 23-mm left adrenal mass (Figure 1).
Trocar placement for left adrenalectomy with the LESS combined technique. The primary 12-mm trocar (A) and a 5-mm nonbladed trocar (B) were located next to one another through a 2.5-cm skin incision. A 3-mm nonbladed trocar (C) was added along the anterior axillary line.
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A 3-mm nonbladed trocar was then placed along the anterior axillary line; afterward, the abdomen was inspected (Figure 2).
Intraoperative findings. (a) Incision of the white line of Toldt, (b) dissection of the junction of the colonic mesentery and Gerota's fascia, (c) renal vein (arrowhead) and left adrenal vein (arrow), and (d) adrenal dissection with a vessel-sealing device.
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Toldt was incised using a combination of 3-mm monopolar scissors (held in the surgeon's right hand) and 5-mm monopolar forceps (held in the surgeon's left hand) (Figure 3(a)), the junction of the colonic mesentery and Gerota's fascia was identified (Figure 3(b)). This plane was then dissected to the renal vein (Figure 3(c)). The adrenal veins were identified, clipped with 5-mm Hem-O-Lok clips (Teleflex Medical, Research Triangle Park, NC, USA), held in the surgeon's left hand, and divided. A 5-mm vessel-sealing device (LigaSure V, COVIDIEN, CT, USA; held in the surgeon's left hand) was also used to complete the adrenal dissection (Figure 3(d)).
Postoperative appearance. A 6-mm tubular drain through the incision near the paraumbilicus was left in situ.
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Finally, the fascia and the skin were closed after a 6-mm tubular drain through the incision was left in situ (Figure 4).