PMC3113211_01
MRI of the abdomen (T1, in phase) showing bilateral adrenal masses (arrows).
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F1
An MRI of the abdomen revealed left and right adrenal masses, 4.8 cm and 3.2 cm at the greatest diameter, respectively (Figure 1).
Seven-centimeter infraumbilical midline hand-port incision.
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F2
A 7-cm incision was made in the exact midline caudad from the umbilicus with the electrocautery on a pure cut through the cutaneous layer, and coagulation thereafter (Figure 2).
Left adrenal mass palpated with the operating left hand.
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F3
The adrenal mass was palpated with the operating left hand (Figure 3) and presented to the dissecting laparoscopic instrument (Figure 4).
Left adrenal mass being presented to the laparoscopic instrument.
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F4
The adrenal mass was palpated with the operating left hand (Figure 3) and presented to the dissecting laparoscopic instrument (Figure 4).
Weck clip application to right adrenal vein.
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F5
Ports were placed in mirror image to those for left-sided dissection, and an additional port was placed in the midupper quadrant to retract the liver (Figure 5). Gentle retraction on the right adrenal gland afforded by the surgeon's hand allowed for maximal identification of its extent and clip application for safe vascular control (Figure 5).