Narrated R Adrenal Coolseal

This video demonstrates the use of the Coal Trinity 5 millimeter device in a right perical adrenal neuroblastoma. This presented in a 3 1/2 year old female who presented with a chronic cough and chest pain. The CT scan showed the right periccaal mass. The procedure was started by mobilizing the hepatic flexure. Here you can see the dual action 5 millimeter jaws used to take the greater momentum off of the right. He right transverse colon and hepatic flexure. This can be done without worry of injury to the colon because of the very low energy profile and heat spread. Adhesions between the gallbladder and the retroperitoneum are now taken down, and again, there is little risk of injury to surrounding structures. The fine tips of the 5 millimeter jaw allow for not only grasping but fine dissection between tissue planes. The tumor is first visualized medial and superior to the right kidney, and the retroperitoneum is opened. Again, the fine tips of the dual action jaws allow us to dissect grass tissues and mobilize structures without the need to exchange instruments. This will become increasingly important as the dissection goes on. There are adhesions up to the right lobe of the liver, and these are taken down using the cool seal device. We can now visualize. The tumor abutting the inferior vena cava. You can see that the tumor is directly on the inferior vena cava, as was represented in the CT scan. And these two structures are densely adherent. The fine dissecting jaws of the Trinity allow us to gently dissect between the two structures. And mobilize the tumor off of the inferior vena cava. The visualization afforded by the dual action and the fine tips is better than All other Tissue sealing devices and is equivalent to that of a 5 millimeter. Maryland. At no time during this procedure did we have to, Remove the trinity and insert a different grasping or dissecting device because of its ability to perform both of these functions. Here, again, you can see the tumor is densely adherent to the inferior vena cava, making the dissection extremely difficult. But continued gentle pressure and dissection allows us to gradually mobilize the tumor off the inferior vena cava. Here we're starting to truly develop the plane between the tumor and the vena cava. And again, the dense adherence of the tumor to the vena cava makes the dissection. Tricky. And somewhat difficult. Once we've developed somewhat of a plane, we're now able to go through the area of the densest adhesions. The fact that the device allows us to. Seal and divide tissues. With separate actions is critically important here. We're able to seal the tissues. And in some cases not divide them to ensure that we have adequate hemostasis. The knife is deployed in a separate motion. And this allows us to safely divide tissues when we're clear that hemostasis is obtained. The superior portion of the dissection. You can see that the tissue is quite thick. And inflamed. And the plane between the tumor and the IVC is difficult to, Identify However, the cool seal allows us to safely dissect in this plane. And seal and divide the tissue when we have adequate exposure. Again, all of this is done without changing. Instruments. During the procedure, which is a significant time saver. Now with the tumor mostly mobilized. Where you're able to circumferentially dissect it from surrounding structures. Again, the minimal heat spread ensures that we will not damage. Any of the adjacent structures, such as the kidney, the liver, bowel, Or the vena cava. Can also note that there is minimal sticking, uh, following the sealing of the tissues. The device is taken out periodically to clean the jaws. To get rid of any small amount of. Char that might be present on them. Here we reach the superior level of the tumor. And we can now be more aggressive in dissecting the tumor off of the cava and down off of the liver. This procedure took under 2 hours. And the tumor was placed in an endoscopic bag and brought out through an elongated umbilical incision. Saving the child significant morbidity from a large open procedure. Again, when we see a little bit of bleeding, we were able to perform seals. On both sides of the tissue and then divided again, ensuring complete hemostasis. This child was discharged on the 2nd postoperative day. The pathology came back consistent with a neuroblastoma arising from the right adrenal gland. Again, the ability of the trinity to grasp tissues, dissect, and safely seal and divide greatly enhanced. The flow and safety of this procedure.