This book will offer for the first time a step-by-step description of the posterior retroperitoneoscopic adrenalectomy, a minimally invasive technique, moving the gold standard of laparoscopic adrenalectomy towards the retroperitoneoscopic approach. Detailed information about the technique, the advantages over other approaches, the technical steps, the potential complications and how to solve them, outcomes, and robotics, will be offered to readers.
This practical guide will be of great interest for all general surgeons and urologists already performing adrenal surgery, and for those that wish to start performing adrenalectomy.
Author(s): Carlos Eduardo Costa Almeida
Publisher: Springer
Year: 2023
Language: English
Pages: 114
City: Cham
Preface
Contents
Contributors
Abbreviations
1: Anatomy of the Adrenal Gland
1.1 Introduction
1.2 The Adrenal Gland
1.2.1 Anatomical Landmarks and Topographic Anatomy
1.2.2 Arterial Supply
1.2.3 Venous Drainage
1.2.4 Lymphatic Drainage
1.2.5 Innervation
1.3 Anatomical Considerations in Posterior Retroperitoneoscopic Adrenalectomy
1.3.1 Retroperitoneum
1.3.2 Abdominal Wall (Posterior and Anterolateral)
References
2: Indications for Adrenalectomy
2.1 Introduction
2.2 Posterior Retroperitoneoscopic Adrenalectomy in Overproduction Adrenal Syndromes
2.2.1 Excessive Production of Aldosterone: Hyperaldosteronism
2.2.2 Excessive Production of Glucocorticoids: Cushing’s Syndrome
2.2.3 Excessive Production of Catecholamines: Pheochromocytoma and Paraganglioma
2.3 Posterior Retroperitoneoscopic Adrenalectomy in Adrenal Malignancies
2.3.1 Adrenocortical Carcinoma
2.3.2 Malignant Pheochromocytoma and Paraganglioma
2.3.3 Metastases to the Adrenal Glands
2.4 Adrenal Incidentaloma
2.5 Partial Adrenalectomy
References
3: Open Versus Minimally Invasive Approach
3.1 Introduction
3.2 Validation of Laparoscopic Adrenal Surgery
3.3 Still a Place for Open
3.4 Open Surgery
3.4.1 Current Indications
3.4.2 Risk of Conversion to Open
3.5 Open Technique
3.5.1 Anterior Approach
3.5.1.1 Technique for the Right Side
3.5.1.2 Technique for the Left Side
3.5.2 Posterior Approach
3.5.3 Thoracoabdominal Approach
3.6 Conclusion
References
4: Retroperitoneoscopic Versus Laparoscopic Adrenalectomy
4.1 Background and Clinical Considerations
4.2 Intraoperative Outcomes
4.3 Postoperative Outcomes
References
5: Retroperitoneoscopic Approach in Malignant Disease
5.1 Introduction
5.2 Preoperative Evaluation of Patients with Adrenal Lesions Suspicious for Malignancy
5.3 Minimally Invasive Adrenal Surgery for Indeterminate Adrenal Nodules Suspicious for Malignancy
5.4 Minimally Invasive Adrenal Surgery for Metastatic Disease
5.5 Minimally Invasive Adrenal Surgery for Adrenocortical Carcinoma
References
6: Anesthesia in Posterior Retroperitoneoscopic Approach
6.1 Introduction
6.2 Preoperative Patient Evaluation
6.3 Anesthesia for PRA
6.4 Postoperative Pain Management
References
7: Technical Steps of Posterior Retroperitoneoscopic Adrenalectomy
7.1 Introduction
7.2 Surgical Instruments and Operation Table Setup
7.3 Surgical Team
7.4 Step-by-Step
7.4.1 Positioning the Patient
7.4.2 Placing the First Trocars (Balloon Trocar and Lateral Trocar)
7.4.3 Creating the Working Space
7.4.4 Placing the Third Trocar (Medial Trocar)
7.4.5 Finding Upper Pole of the Kidney
7.4.6 Finding the Inferior Vena Cava (IVC)
7.4.7 Dissecting and Ligating the Adrenal Vein
7.4.8 Dissecting the Entire Gland
7.4.9 Retrieving with an Extraction Bag
7.4.10 Final Check (Hemostasis) and Closure
7.5 Tips and Tricks
7.6 Video of Posterior Retroperitoneoscopic Adrenalectomy
7.7 Postoperative Care
7.8 Final Notes
References
8: Intraoperative Complications
8.1 Introduction
8.2 Vascular Injury, Hemorrhage, and Cardiovascular Complications
8.3 Retroperitoneal Fatty Tissue
8.4 Injuries of the Intestine
8.5 Injuries to Other Organs
8.6 Abdominal Wall Relaxation and Hypoesthesia
8.7 Pleural Lesions
8.8 Misplacement of Trocars
8.9 Rare Complications
8.10 Risk Factors for Intraoperative Complications
8.11 Laparoscopic Versus Retroperitoneoscopic Adrenalectomy
References
9: Management of Vascular Injuries (IVC)
9.1 Introduction
9.2 The Major Vascular Complication
9.3 Surgical Team and Operation Room Staff Preparation
9.4 Vascular Injury Repair
9.4.1 How to Do It?
9.5 Vascular Injuries and Learning Curve
9.6 Case Report
References
10: Converting to Open Surgery
10.1 Introduction
10.2 Definition of Conversion to Open Surgery
10.3 Risk Factors Associated with Conversion to Open Surgery during Transperitoneal Laparoscopic Adrenalectomy
10.3.1 Obesity
10.3.2 Size of the Tumor
10.3.3 Pheochromocytoma
10.4 How to Convert?
10.4.1 Choice of Incision
10.4.2 Open Right Adrenalectomy
10.4.3 Open Left Adrenalectomy
10.5 Concluding Remarks
References
11: Final Outcomes
11.1 Introduction
11.2 Operative Time
11.3 Complication Rate and Mortality
11.4 Conversion Rate and Blood Loss
11.5 Postoperative Pain
11.6 In-Hospital Days and Recovery to Normal Activity
11.7 Learning Curve
11.8 Final Notes
References
12: Robotic Surgery and Innovation
12.1 Introduction
12.2 Surgical Technique of Robotic Posterior Retroperitoneal Adrenalectomy
12.3 Preoperative Preparation and Setup of the Patient
12.4 Evidence Regarding Robotic Posterior Retroperitoneal Adrenalectomy
12.4.1 Case Series
12.4.2 Laparoscopic Versus Robotic Posterior Retroperitoneal Adrenalectomy
12.4.3 Robotic Posterior Retroperitoneal Adrenalectomy Versus Transabdominal Lateral Robotic Adrenalectomy
12.4.4 Cost Analysis
References
