Mayo stand and back table instruments for Laparoscopic Adrenalectomy surgery setup

Clamping & Occluding

• 

  Curved Hemostat

• 

  Kelly Forceps

• 

  Laparoscopic Clip Appliers

Cutting & Dissecting

• 

  #3 Knife Handle

• 

  L Hook Cautery

• 

  Laparoscopic Metz Scissor

• 

  Metzenbaum Scissor

• 

  Straight Mayo Scissor

Grasping & Holding

• 

  Adson Forceps

• 

  Alligator Grasper

• 

  Laparoscopic DeBakey Forceps

• 

  Laparoscopic Maryland Dissector Grasper

• 

  Laparoscopic Wave Grasper

Misc

• 

  Camera Cord

• 

  Laparoscope

• 

  Light Cord

Retracting & Exposing

• 

  Army-Navy Retractor

• 

  Fan Retractor

• 

  Hasson S Retractor

• 

  Nathanson Hook Liver Retractors

Suctioning

• 

  Suction Irrigator

• 

  Yankauer Suction

Suturing & Stapling

• 

  Mayo-Hegar Needle Holder

• 

  Ryder Needle Holder

What to expect during Laparoscopic Adrenalectomy

Drapes: Folded towel with towel clips and Laparotomy drape

Anesthesia: General

Surgery Steps: Once the patient has been prepped and draped, an 11 or 15 blade (doctor’s preference) on a #3 knife handle can be used to make a small incision where a Verres needle can be inserted and connected to the CO2 tubing for inflation. More incisions will be made to place the doctor’s preferred ports in (usually two 5mm and one 12mm), and the 30 degree laparoscope connected to the camera and light cord will be inserted through one of the ports.

Once all the ports are placed, basic laparoscopic instruments such as alligator graspers, Debakey graspers, or wave graspers, laparoscopic scissors, different sized laparoscopic clip appliers, L hook cautery, a laparoscopic Harmonic scalpel, and sometimes a Maryland are all used to mobilize the colon and spleen, and take down any adhesions or ligaments in order to reach the adrenal vein. If doing a right sided adrenalectomy, a liver retractor will need to be used to keep the liver out of the way.

Once the adrenal vein is reached, the laparoscopic clip appliers will be used to clamp them off and then they will be cut using the Harmonic scalpel. More dissection will be done with the same instruments before in order to free up the adrenal gland, and an EndoCatch or some sort of retrieval bag will be inserted through a port and used to pull the gland out when it is fully dissected.

A suction irrigator will be used to irrigate the abdomen, and hemostasis will be ensured before turning off the CO2 and removing the ports and camera.

2-0 Vicryl is commonly used to close the 12mm port site, followed by 4-0 Monocryl or Nylon to close the skin and smaller port sites. S retractors or Army-Navy may be used while suturing with the Vicryl to hold the excess tissue out of the way.