Retroperitoneal hand-assisted laparoscopic surgery for endoscopic adrenalectomy

Forty-Three-Year-Old Female with Dopamine Secreting Pheochromocytoma of the Adrenal Gland

We report on a 43-year-old, asymptomatic female who presented with incidental finding of left adrenal mass. MRI gave concerns for possible pheochromocytoma but markers for pheochromocytoma were not elevated as expected. 24-hour urine dopamine levels (6988 μg/day) were significantly elevated. The patient successfully underwent robotic assisted radical left adrenalectomy and was diagnosed with a dopamine secreting pheochromocytoma. Pathology revealed increased malignant potential associated with the tumor. The patient underwent full metastatic workup, which was negative. At two years of follow-up there was no recurrence and normalization of lab values.

Design, Analysis, and Experimental Evaluation of a Novel Three-Fingered Endoscopic Large-Organ Grasper

The currently available laparoscopic instruments are unable to manipulate and grasp the large intra-abdominal organs, such as spleen and kidney, with sufficient stability and safety. This paper describes a novel three-fingered endoscopic instrument, based on parallelogram mechanism, which can fully constrain the large organs and provide an effective grasping function. We first evaluated the efficacy of the design using a 3D model and finite element analysis. Then, a fully functional prototype was fabricated for experimental evaluations, including force propagation and pull force limitation characteristics. Finally, the instrument's capability for effective grasping was investigated on animal specimens in in vitro and in vivo examinations. The results of the force propagation analysis indicated a high amplification ratio of more than 1.2 for the actuating force when grasping large organs. The pull force experiments on a sheep heart specimen revealed a nearly linear relationship between the actuating force and the limit of the pulling force that could be attained without slippage. The resulting pinch force, however, was found to be injurious if the actuating force exceeded a limit of 8.6 N. The in vitro and in vivo examinations of the instrument indicated its capability to pass through a standard 10-mm trocar to enter the abdomen, open its fingers to a diameter of about 80 mm, and grasp and manipulate organs with different sizes, shapes, and properties. With further developments, the proposed design is expected to provide a practical and feasible solution for grasping of large organs during endoscopic operations. However, more preclinical examinations are needed to evaluate the potential risks of using rigid jaws against injury-prone soft organs.

An exclusively dopamine secreting paraganglioma in the retroperitoneum: a first clinical case in Korea

Exclusively dopamine producing retroperitoneal paragangliomas are extremely rare. We have experienced the first Korean case managed successfully based on the proper evaluation. A 26-year-old female patient came to our attention after the accidental detection of an adrenal mass. She had no symptoms and denied any family history. Laboratory evaluations were normal but serum dopamine (425 ng/L) and 24-hour urine dopamine levels (1,565.3 µg/day) were elevated. She underwent laparoscopic right adrenalectomy. Histopathological diagnosis was a paraganglioma. After operation, dopamine levels in serum and 24-hour urine dropped to 0.09 ng/L and 388.4 µg/day. Dopamine producing paraganglioma elicit no clinical symptoms. Only the dopamine level is elevated in serum and 24-hour urine samples. Surgical resection without using preoperative alpha blockage is the treatment of choice. The prognosis for patients with this tumor tends to be poor because the diagnosis is usually delayed due to lack of symptoms.