Thoracoscopic Transdiaphragmatic Adrenalectomy

Thoracoscopic transdiaphragmatic adrenalectomy is a procedure that may be of particular use in patients who have had extensive surgery both in the peritoneal cavity and the retroperitoneum.

Initially described by Pompeo et al. in a porcine model (89), this approach was further developed and the initial clinical series described by Gill et al. (12). In this series, the procedure was performed initially on four cadavers to develop the technique and then on three patients, all of who had significant abdominal scarring and prior ipsilateral renal surgery. After the placement of a double-lumen endotracheal tube, the patient is placed prone and a four-port transthoracic approach without pneumoinsufflation is used. Real-time laparoscopic ultrasound is used to identify the adrenal gland transdiaphragmatically. The diaphragm is incised, and the adrenal gland dissected. There were no intraoperative or postoperative complications, operative times ranged from 2.5 to 6.5 hours, and blood loss ranged from 50 to 500 mL (12).

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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