Mayo stand and back table instruments for Laparoscopic Adrenalectomy surgery setup

Clamping & Occluding

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  Curved Hemostat

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  Kelly Forceps

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  Laparoscopic Clip Appliers

Cutting & Dissecting

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  #3 Knife Handle

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  L Hook Cautery

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  Laparoscopic Metz Scissor

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  Metzenbaum Scissor

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  Straight Mayo Scissor

Grasping & Holding

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  Adson Forceps

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  Alligator Grasper

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  Laparoscopic DeBakey Forceps

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  Laparoscopic Maryland Dissector Grasper

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  Laparoscopic Wave Grasper

Misc

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  Camera Cord

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  Laparoscope

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  Light Cord

Retracting & Exposing

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  Army-Navy Retractor

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  Fan Retractor

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  Hasson S Retractor

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  Nathanson Hook Liver Retractors

Suctioning

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  Suction Irrigator

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  Yankauer Suction

Suturing & Stapling

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  Mayo-Hegar Needle Holder

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  Ryder Needle Holder

What to expect during Laparoscopic Adrenalectomy

Laparoscopic Adrenalectomy is a minimally invasive surgery that involves removing one or both adrenal glands using small incisions in the abdomen. The surgery is typically performed to treat tumors or other conditions that affect the adrenal glands, such as hormone imbalances or cancer. The procedure is performed using specialized instruments and a laparoscope, which is a thin, flexible tube with a camera and light attached to it that allows the surgeon to see inside the abdomen. Laparoscopic Adrenalectomy typically results in less pain, shorter hospital stays, and faster recovery times compared to traditional open surgery.

Drapes
Folded towel with towel clips and Laparotomy drape

Anesthesia
General

Step 1: Making Incisions and Inserting Ports
The surgeon will use an 11 or 15 blade (doctor’s preference) on a #3 knife handle to make a small incision where a Verres needle can be inserted and connected to the CO2 tubing for inflation. Additional incisions will be made to insert the doctor’s preferred ports (usually two 5mm and one 12mm).

Step 2: Inserting the Laparoscope
Once all the ports are in place, the 30-degree laparoscope connected to the camera and light cord will be inserted through one of the ports.

Step 3: Mobilizing the Colon and Spleen
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 used to mobilize the colon and spleen, and take down any adhesions or ligaments in order to reach the adrenal vein.

Step 4: Using a Liver Retractor (If Necessary)
If the surgery is a right-sided adrenalectomy, a liver retractor will need to be used to keep the liver out of the way.

Step 5: Clamping and Cutting the Adrenal Vein
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.

Step 6: Dissecting and Removing the Adrenal Gland
More dissection will be done with the same instruments 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.

Step 7: Hemostasis and Irrigation
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.

Step 8: Closing the Incisions
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.

The Surgery Sparknotes

1. Make incisions and insert ports
2. Insert laparoscope
3. Mobilize colon and spleen
4. Use liver retractor if necessary
5. Clamp and cut adrenal vein
6. Dissect and remove adrenal gland
7. Hemostasis and irrigation
8. Close incisions