[Optimization of preoperative planning for laparoscopic adrenalectomy].

OBJECTIVE

To evaluate the effectiveness of preoperative CT in supine and lateral position for analysis of optimal trocar placement.

MATERIAL AND

METHODS

We performed 32 laparoscopic adrenalectomies in patients with endocrine active adrenal glands. CT in lateral position was used for preoperative planning.

RESULTS

CT-based planning was carried out according to the above-mentioned methodology. Adrenal gland displacement was assessed in sagittal plane. Considering these data, we planned surgical action plane that made it possible to simulate necessary optical axis of laparoscope. According to CT data in lateral position, adrenal gland with tumor shifts anteriorly by 2.5-5 cm and medially by 2 cm. Depth of surgical action always decreases compared to supine position. If the distance between dorsal edge of tumor and anterior abdominal wall is 20 cm or more, trocar site is set along the mid-clavicular line in hypochondrium on the side of intervention, if less than 20 cm - along the mid-clavicular line in lateral area on the side of intervention.

CONCLUSION

CT in upcoming position allows us to preoperatively simulate intraoperative position of adrenal gland, assess its displacement and determine optimal trocar placement in a situation as close as possible to the operating theater, improve ergonomics and quality of surgical work, reduce the risk of intraoperative complications.