Retroperitoneoscopic adrenalectomy in four dogs using SILS device

Four female intact dogs were enorolled for this study. Left adrenalectomy was performed based on the presence of hypercortisolism in all cases. These cases were diagnosed on citology after fine needle aspiration (FNA) carcinomas. CT whole body was done for all dogs. No adrenal gland vascular invasion was seen. Dogs were positioned in lateral recumbency with lumbar elevation using a cushion and secured with self-adhesive tape. The dorsal and lateral aspect of the hemithorax and hemiabdomen was clipped from the level of the 11th thoracic vertebra to the level of the seventh lumbar vertebra for aseptic surgery (Fig. 1). To access the retroperitoneal space, needed to transect the skin, fascia, and separate muscular layers. A SILS port (Covidien, New Haven, Connecticut) was placed by using a stay suture for retraction of the skin and muscles (Fig.2). After placing three 5-mm cannulas through the SILS port (Fig.3) for triangulation of the laparoscopic instruments, the retroperitoneal space was investigated by using a 5-mm, 0° telescope (Karl Storz, Tuttlingen, Germany). When the retroperitoneal space was visualized, pneumoretroperitoneum was induced by using an insufflator (Karl Storz) at a pressure of 5 mmHg. An ultrasonic scalpel (HarmonicTM or SonicisionTM) was used to accomplish the vascular dissection and sealing. Other’s devices, as advanced bipolar sealers, were also used. Dissection started with the surgical plane between the fat pad and the lateral aspect of the kidney to gain access to the adrenal gland Retroperitoneoscopic examination of the kidney and its pedicle, adrenal gland, vena cava and the indemnity of the peritoneum was done (Fig.4). Absence of liver macrometastases and macroscopic vascular invasion into the caudal vena cava was confirmed in all dogs. The distal segment of the phrenicoabdominal vein was identifed, sealed, and transected. Exposure and dissection of the adrenal glands were performed from caudal to cranial (close to far from the camera) (Fig.4). After careful dissection, the remaining glandular tissue was progressively entirely removed along with the SILS port to prevent abdominal wall contamination. The retroperitoneal space was inspected for hemorrhage, and the adrenalectomy site was locally rinsed with small volumes of warmed lactated Ringer solution and concurrent use of close suction to avoid abdominal contamination with neoplastic cells. All remaining gas must be aspirated to avoid postsurgical pain. After the total gas elimination, the incision is closed