this is early experiences of laparoscopic adrenal tumor removal in cmh Rawalpindi Pakistan which need more focus and innovation . it is less pain full and early recovery ensuere

1. Lap adrenalectomy
early experience
DR IBRAHIM BALOCH
RESIDENT CMH RAWALPINDI, PAKISTAN

2.  perhaps no organ is better suited for laparoscopic surgery than the adrenal
gland, by reason of its small size and its relatively difficult location in the
retroperitoneum

3. • Laparoscopic adrenalectomy was described in 1992 by Gagner et al.
• Laparoscopic adrenalectomy has become the gold standard for the surgical
treatment of most adrenal problem.
• The benefits: decreased hospital stay, shorter recovery time and improved
patient satisfaction (decrease post-op pain and better cosmetic)
History

7. Approaches to adrenalectomy
 Open
 Transperitoneal
 Retroperitoneal
 Laparoscopic
 Transperitoneal
 Retroperitoneal
7

8. Right adrenalectomy
 Retraction of liver
 Division of peritoneum
 Identification of infra hepatic IVC
 Dissection along IVC
 Identification of right adrenal vein and division
 Identification of right renal vein
 Division of arteries and veins
 Hemostasis
 Removal of adrenal

9. Left adranalectomy
 Division of phrenico colic ligament
 Division of left gastrocolic omentum and entry into lesser sac
 Short gastric division and retraction of stomach
 Dissection from tail of pancreas
 Dissection along medial side
 Identification of common vein – adrenal and inferior phrenic
 Division of vein
 Identification of renal vein
 Division of rest of arteries and veins
 Hemostasis
 Removal of the gland

10. 10

11. 11

12. 12

13. Position 13

14. 14

15. 15

16. 16

17.  decreased blood loss, lower morbidity, shorter hospitalization, faster
recovery, and overall cost-effectiveness in comparison with the open
approach.

18. Right Left
Side 24 15 09
Histology benign adenomas 19
pheochromocytoma 05
11
04
08
01
Blood loss 2
size 03-12 cm
Operating time 90-180 min
Morbidly Pneumonia
Wound infection
02
nil
nil
01
Mortality PE 01 nil

19. Thank you
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