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  • 1. Introduction
  • 2. Surgical Approach
  • 3. Access and Placement of Ports (Right Side)
  • 4. Adrenal Gland Exposure (Right Side)
  • 5. Dissection of the Adrenal Gland (Right Side)
  • 6. Specimen Extraction (Right Side)
  • 7. Final Check for Hemostasis (Right Side)
  • 8. Closure (Right Side)
  • 9. Access and Placement of Ports (Left Side)
  • 10. Adrenal Gland Exposure (Left Side)
  • 11. Dissection of the Adrenal Gland (Left Side)
  • 12. Specimen Extraction (Left Side)
  • 13. Closure (Left Side)
  • 14. Post-op Remarks
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Bilateral Posterior Retroperitoneoscopic Adrenalectomy with Cortical Sparing on Right Side

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Procedure Outline

  1. Patient positioning
  2. Identification of external landmarks
  3. Marking
  1. Perform transverse incision just inferior to tip of the 12th rib
  2. Sharp entry into the retroperitoneum
  3. Use finger to manually bluntly create a small open retroperitoneal space
  4. Placement of 5-mm medial and lateral ports under manual guidance
  5. Place 10-mm balloon port and insufflate the retroperitoneum
  6. LigaSure to open the retroperitoneal space
  7. Identify the paraspinal muscles and the superior pole of the kidney
  8. Mobilize the adrenal gland inferiorly and retract the kidney downward
  9. Identify the IVF and mobilize the adrenal gland off the surface, medially and laterally
  10. Identify the adrenal vein, preserve if possible, otherwise clip and divide
  11. Divide the normal adrenal parenchyma from the culprit tumor
  12. Divide the superior attachments suspending the adrenal gland
  13. Place the gland in an Endocatch device and remove it from the retroperitoneum
  14. Inspect for hemostasis
  1. Close the fascia in the 10-mm port site
  2. Close the skin