Laparoscopic surgery is a surgical technique in which short, narrow tubes (trochars) are inserted into the abdomen through small (less than one centimeter) incisions. Through these trochars, long, narrow instruments are inserted. The surgeon uses these instruments to manipulate, cut, and sew tissue. The advantages include reduced pain due to smaller incisions, reduced hemorrhaging, and shorter recovery time. The key element is the use of a laparoscope, a long fiber optic cable system that allows viewing of the affected area by snaking the cable from a more distant, but more easily accessible location. Right Adrenalectomy: Since its first description in 1992, laparoscopic adrenalectomy has become the gold standard for the surgical treatment of most adrenal conditions. The benefits of a minimally invasive approach to adrenal resection such as decreased hospital stay, shorter recovery time and improved patient satisfaction are widely accepted. However, as this procedure becomes more widespread, critical steps of the operation must be maintained to ensure expected outcomes and success. This presentation reviews the surgical techniques for the laparoscopic adrenalectomy. Presented by: Mohammadsaleh Moallem

1. LAPAROSCOPIC SURGERY
Mohammad saleh Moallem

2. Episode 3 questions:
What is laparoscopic surgery? (laparoscopic right adrenalectomy).
What kinds of operations can be performed using laparoscopic
surgery?
QUESTION

3. LAPAROSCOPIC SURGERY
Laparoscopic surgery is a surgical technique in which short, narrow
tubes (trochars) are inserted into the abdomen through small (less
than one centimeter) incisions. Through these trochars, long, narrow
instruments are inserted. The surgeon uses these instruments to
manipulate, cut, and sew tissue.
Although patients tend to think of laparoscopic surgery as minor surgery,
it is major surgery with the potential for major complications – visceral
injury and bleeding, injury to the bowel, or injury to the bladder.

4. Laparoscopic surgery is a surgical technique in which short, narrow
tubes are inserted into the abdomen through small incisions.
LAPAROSCOPIC SURGERY

5. DEFINITION
Laparoscopic surgery, also
called minimally invasive
surgery (MIS), bandaid
surgery, or keyhole surgery,
is a modern surgical
technique.

6. VS
Laparoscopic
surgery
Exploratory
laparotomy

7. ADVANTAGES
The advantages include
reduced pain due to smaller
incisions, reduced
hemorrhaging, and shorter
recovery time.

8. TNE KEY ELEMENT
The key element is the use of
a laparoscope, a long fiber
optic cable system that
allows viewing of the affected
area by snaking the cable
from a more distant, but more
easily accessible location.

9. Laparoscopic surgery includes operations within the abdominal or
pelvic cavities, whereas keyhole surgery performed on the thoracic
or chest cavity is called thoracoscopic surgery.
LAPAROSCOPIC SURGERY

10. TYPES OF LAPAROSCOPES
a telescopic rod lens system, usually connected to a video
camera (single-chip or three-chip)
a digital laparoscope where a miniature digital video
camera is placed at the end of the laparoscope, eliminating
the rod lens system
1.
2.
There are two types of laparoscope:

11. Reduced hemorrhaging, which reduces the chance of needing a blood
transfusion.
Smaller incision, which reduces pain and shortens recovery time, as
well as resulting in less post-operative scarring.
Less pain, leading to less pain medication needed.
1.
2.
3.
ADVANTAGES

12. 4.The use of regional anesthesia for laparoscopic surgery, as opposed to
general anesthesia required for many non-laparoscopic procedures, can
produce fewer complications and quicker recovery.
5. Although procedure times are usually slightly longer, hospital stay is less,
and often with a same day discharge which leads to a faster return to
everyday living.
6. Reduced exposure of internal organs to possible external contaminants
ADVANTAGES

13. Although laparoscopy in adults is widely accepted, its advantages in
children are questioned. Benefits of laparoscopy appear to recede with
younger age.
Efficacy of laparoscopy is inferior to open surgery in certain conditions
such as pyloromyotomy for infantile hypertrophic pyloric stenosis. Although
laparoscopic appendectomy has less wound problems than open surgery,
the former is associated with more intra-abdominal abscesses.
NOTE!

14. Laparoscopic surgery requires pneumoperitoneum for adequate
visualization and operative manipulation.
The surgeon has a limited range of motion at the surgical site, resulting
in a loss of dexterity.
Poor depth perception.
1.
2.
3.
DISADVANTAGES

15. Surgeons must use tools to interact with tissue rather than manipulate it
directly with their hands. This results in an inability to accurately judge how
much force is being applied to tissue as well as a risk of damaging tissue
by applying more force than necessary. This limitation also reduces tactile
sensation, making it more difficult for the surgeon to feel the tissue and
making delicate operations such as tying sutures more difficult.
DISADVANTAGES

18. Lacroscopic right colectomy

19. Lacroscopic gastrectomy for gastric cancer

20. RIGHT ADRENALECTOMY

21. RIGHT ADRENALECTOMY
Since its first description in 1992, laparoscopic adrenalectomy
has become the gold standard for the surgical treatment of
most adrenal conditions. The benefits of a minimally invasive
approach to adrenal resection such as decreased hospital
stay, shorter recovery time and improved patient satisfaction
are widely accepted. However, as this procedure becomes
more widespread, critical steps of the operation must be
maintained to ensure expected outcomes and success. This
article reviews the surgical techniques for the laparoscopic
adrenalectomy.

22. RIGHT ADRENALECTOMY
The first laparoscopic adrenalectomy (LA), a minimally
invasive surgical approach has almost replaced the open
adrenalectomy in the management of small and medium-
sized adrenal lesions. The advantages of LA include
shorter hospital stays, decreased postoperative pain,
improved recovery times, and better cosmetic results.
Saleh

23. RIGHT ADRENALECTOMY
In addition, difficulty with open surgical exposure and the
small size of the adrenal gland make this organ
particularly amenable to a minimally invasive technique.
The anatomical location of the adrenal gland has led to a
number of laparoscopic approaches, including posterior
or lateral retroperitoneal, transthoracic, and lateral
transperitoneal. In this paper we review the varied surgical
techniques used for LA.
Saleh

24. Left adrenalectomy. Exposure of the adrenal gland is obtained by laterally retracting the kidney
and adrenal with a PEER retractor

25. Identification of the left adrenal vein and subsequent division after dissection
and clipping

26. Left adrenalectomy medial dissection. The medial dissection and inferior adrenal dissection
is complete, exposing the crus of the diaphragm and the posterior abdominal wall

27. Left adrenalectomy, lateral dissection. The lateral dissection begins with establishing a plane between the
upper pole renal cortex and the adrenal gland. It requires careful attention for upper pole renal vessels

28. Adrenal bed after adrenalectomy. The adrenal gland with its surrounding
periadrenal and peri-renal fat, has been excised

29. THANK YOU!
Mohammad saleh Moallem
默汉201816230152
Saleh