Adrenal sparing giant adrenal cyst excision by 3D laparoscopic approach: a case report

Adrenal cyst is rare clinical entity. Usually they are asymptomatic, non-functional, <10 cm in size and often discovered incidentally. We report a left adrenal cyst in 58-year-old woman measuring 23 cm in diameter, displacing left kidney infero-medially and pancreas anteriorly, because of its huge size. She presented with left flank pain over a 6-month period. Serial abdominal ultrasound and CT imaging revealed left suprarenal cystic mass of size 10 cm to begin with and gradually increased to size of 23 cm over period of 10 years when she became symptomatic. All laboratory and endocrine function tests were normal. 3D laparoscopic surgery done and cyst was completely removed with preservation of adrenal gland. Histopathological examination revealed a benign endothelial adrenal cyst. The postoperative course was uneventful and patient had no evidence of recurrence during follow-up. The giant adrenal cysts are relatively rare and represent great surgical challenge during resection.

Three-dimensional versus two-dimensional laparoscopy in urology: A randomized study

Introduction: Conventional two-dimensional (2D) laparoscopy systems have the drawback of poor depth perception and spatial orientation. Three-dimensional (3D) laparoscopic systems have stereoscopic vision in which depth perception is achieved by different unique images received by each eye. We evaluated 3D laparoscopy in comparison with conventional 2D laparoscopy in urological procedures in a prospective randomized study. Materials and Methods: Over a 19 month study period, 108 patients scheduled to undergo various urological procedures were randomized to either conventional 2D or 3D laparoscopy (2D n = 53; 3D n = 55). A single senior surgeon performed all the surgeries. Parameters such as total operative time, dissection and suturing time, blood loss, hospital stay, complications (Clavien-Dindo), and visual analog scale (VAS) score for pain were assessed. The subjective assessment of the operating surgeon of superiority and inferiority of either technology on parameters defining surgical skills was recorded using a Likert scale. Results: The total operative time (P < 0.0003), blood loss (P < 0.028), dissection, suturing and stenting time (P < 0.0001), and the State-Trait Anxiety Inventory for Adults score (P < 0.0001) was significantly in favor of 3D laparoscopy. Post operative pain, hospital stay, and complications after surgery were similar in both groups. The subjective assessment of the operating surgeon also favored the 3D system. Conclusion: Our study showed significant advantages of the 3D system over 2D laparoscopy. These advantages include enhanced operative performance and greater surgeon comfort