Sally Lee/Dr. Thomas J. Fahey - Week 1

 

Week 1 - Laparoscopic Adrenalectomy

Name: Sally

Mentor: Dr. Thomas J. Fahey

    On June 9th, I observed Dr. Fahey perform a laparoscopic adrenalectomy on a patient with adrenal tumor. The adrenal gland, located on top of the kidneys, consists of two main parts: the outer layer called the adrenal cortex and the innermost part known as adrenal medulla. The cortex is responsible for synthesizing and releasing steroid hormones including cortisol, aldosterone, and sex hormones. On the other hand, the medulla releases catecholamines, primarily epinephrine and norepinephrine. In this particular case, the patient exhibited elevated levels of both cortisol and epinephrine/norepinephrine, which is considered a rare occurrence. To address the condition, the patient underwent the removal of the left adrenal gland during the procedure. 

    The surgery began with the patient being positioned securely on the operating table. The patient was placed on their side, allowing the spleen, which is located laterally to the adrenal glands, to be displaced for better exposure of the surgical area. To gain access to the abdominal cavity, three small incisions were made in the abdomen. Trocars, specialized instruments with a tube-like structure, were inserted into the incisions to create entry points for laparoscopic instruments used during the procedure. These instruments included a laparoscope for visualization, retractors to hold tissues, an Endo Peanut for manipulation, EndoCatch device for specimen retrieval, and a laparoscopic sealer/divider for cutting and sealing. 

    The laparoscope, inserted through one of the trocars, provided a real-time video feed displayed on monitors in the operating room. This allowed surgical team to visualize the internal organs and tissues with great detail. With the guidance of the laparoscope, the surgeon identified the location of the spleen and incised the tissues beneath it using the laparoscopic sealer/divider, which employs electrical energy to generate heat for tissue cutting and sealing. This exposed the left adrenal gland and the surgeon proceeded with removing the organ. Throughout the procedure, retractors and Endo Peanut instrument were used to hold and manipulate tissues, ensuring clear access to the targeted area. The surgeon also identified the vein situated between the two adrenal glands and clipped the vein using a laparoscopic clip applier. This step was crucial for occluding the vein and preventing blood flow beyond the clipped point. The blood pressure was closely monitored to verify that there is no additional veins present. Subsequently, the laparoscopic divider was used to cut the vein. Once the left adrenal with the tumor was isolated, the EndoCatch device was used to encapsulate the specimen within a specialized endoscopic bag for retrieval. The device was positioned around the organ, and its ring was closed to seal the bag. The trocar was then removed and a larger incision was made to the already incised area to accomodate the retrieval of the bagged specimen. Finally, all incisions were closed. 

    Observing the laparoscopic adrenalectomy provided valuable insights into the surgical techniques used and the utilization of various instruments during the procedure. It highlighted the precision and advantages of minimally-invasive laparoscopic surgery.