IPEG 2018 - LAPAROSCOPIC RESECTION OF A 13 CM ADRENAL MASS IN A 13 YEAR OLD GIRL

Thank you for that opportunity. We will show a laparoscopic resection of a 13 centimeter left adrenal tumor in a 13-year-old girl. This is a 13-year-old girl with FAP syndrome who had multiple tubular adenomas and colonoscopy. She was evaluated after her father was diagnosed with stage 4 colon cancer at the age of 34. During her laparoscopic total procto colectomy, she was noted to have a large left retroperitoneal mass. Due to this intraoperative finding, she instead had a total abdominal colectomy with a diverting ileostomy in order to further work up the abdominal mass. She had no other medical problems. Her review of systems was notable for hematochezia. On exam, she had a normal heart rate and blood pressure. She also had a BMI of 15 and a firm palpable left-sided abdominal mass. Her urine catecholamines were normal, as were a random cortisol, ACTH, and aldosterone levels. A CT scan showed a large 14 by 13 by 8 centimeter calcified left retroperitoneal mass. It was displacing the left kidney inferiorly. We placed her in a modified right lateral decubitus position. We used 45 millimeter ports. We started by incising the peritoneal layer overlying the left adrenal mass. We used a combination of the ligature device and blunt dissection to reflect the pancreas medially off the anterior surface of the mass. We then move to expose the inferior aspect of the mass. You can appreciate the separation between the left adrenal mass and the left kidney, which is the organ located towards the bottom right-hand portion of the screen. As we come around the mass inferiorly and medially, we notice the golden hue that is characteristic of the adrenal gland. Given the size of the mass, it was easier to proceed with the dissection and mobilize along the posterior aspect, reflecting it anteriorly. Here we come through the attachments attaching the spleen and mobilize it medially as well. We finished circumferentially mobilizing the mass laparoscopically by taking down the final diaphragmatic attachments. Once we are finally free, we place a 15 centimeter endocach bag through a small fan and steel incision. We bring the mass down to the pelvis and extend the fan and steel to remove the mass in its entirety. On final pathology, this was noted to be a 14 centimeter adrenal cortical neoplasm with adjacent normal adrenal gland. It was completely encapsulated and the patient was discharged on a regular diet on postoperative day 4.