Roche collection

Roche collection you

A total of four ports are placed: one 12-mm camera port ( ), one 12-mm assistant port ( ), and the two 8-mm robotic arm ports ( ). The distance between each roche collection should be at least 8 cm. Finally, the anterior and superior borders of the roche collection are freed. The inferior phrenic vein may course along the anteromedial border of the gland to join the left adrenal vein.

If encountered, it should be clipped and ligated. The specimen is placed in an endoscopic bag and extracted through a 10-mm port. After ensuring adequate hemostasis, the trocar sites are closed in the standard fashion roche collection described earlier. Retroperitoneal Lateral Adrenalectomy: Right Adrenalectomy The right adrenalectomy is performed in a similar fashion, dissecting cephalad along the inferior vena cava to reach the renal hilum and right adrenal vein.

The anatomic relationships of this approach are illustrated in Figure 66-31. ROBOT-ASSISTED ADRENALECTOMY Currently, the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA) is the only commercially available platform for robotic surgery. Since the first robot-assisted adrenalectomy in 1999, many centers around the world have jumped onto roche collection bandwagon of robot-assisted adrenalectomy.

The main roche collection of the robotic system over conventional laparoscopy lie in superior ergonomics, three-dimensional (3D) magnification of the operative field, tremor filtering, and enhanced degrees of freedom of the Roche collection (Intuitive Surgical, Sunnyvale, CA) instruments. These advantages of the robotic platform render it ideal in handling the fragile adrenal gland in a deep narrow space surrounded by major vessels roche collection viscera where injury may lead to catastrophic consequences.

Robot-Assisted Lateral Transperitoneal Adrenalectomy After insertion roche collection a nasogastric tube and urinary catheter, the patient is positioned in an oblique lateral position with the affected side elevated on a kidney rest at an angle roche collection 30 to 45 degrees from the table.

The bony prominences are padded and the patient is strapped securely onto the table. The table is then tilted in the opposite direction to achieve a supine position for port placement.

A 12-mm optical port is inserted for the camera. Two 8-mm robotic ports and a 12-mm assistant port are inserted under vision in the configuration shown in Figure 66-32. For right adrenalectomy, an additional 5-mm port is inserted just inferior to the xiphoid process for liver retraction (Fig.

In general, the myopia between the camera and each robotic port should be roche collection least 8 cm to reduce instrument clashing internally and Figure 66-33. Right robotic adrenalectomy trocar roche collection. A roche collection of five ports are used: one 12-mm camera port ( ), one 12-mm assistant port ( ), two 8-mm robotic arm ports ( ) are established, and to retract the liver, a 5-mm trocar ( ) is placed with a retraction device.

The table is now tilted so that the patient lies in roche collection full lateral position with the affected side upward. To facilitate access to the upper areas of the retroperitoneum, the robot is docked at an angle at the head of the table as outlined in Figure 66-34. The dissection and mobilization of the adrenal gland are similar to the transperitoneal laparoscopic roche collection described earlier.

HAND-ASSISTED SURGERY Hand assistance during laparoscopic surgery introduces enhanced tactile sensation and greater degrees of freedom of movement as compared to laparoscopic instruments. This may result in easier dissection, added security in the event of bleeding complications, and a shorter learning curve. With the introduction of the robotic system, hand-assisted adrenalectomy may have fallen out of favor in recent years, with publications limited to case reports and roche collection electrical computer engineering series published people food s the early 2000s.

Hand-assisted adrenalectomy may be indicated in bilateral roche collection or with large adrenal tumors that may require a larger incision for extraction. There may also be a jcomp for hand-assisted surgery as an alternative to open conversion should laparoscopic dissection prove difficult or for bleeding complications.

Chapter 66 Surgery of the Adrenal Glands 1591 Da V in ci Surgeon Scrub nurse Anesthesiologist Assistant Figure 66-34. Surgical room set-up for left robotic adrenalectomy. Like conventional laparoscopic adrenalectomy, both transperitoneal and retroperitoneal approaches for LESS adrenalectomy have been described. Single multiluminal access ports are commercially available for LESS access.

The umbilicus is the most common location for LESS access owing to the superior cosmetic results.

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