Laparoscopic adrenalectomy for Conn's syndrome complicated by ipsilateral congenital pelvic kidney.

A patient presented with hypertension, hypokalemia, and a 1.2-cm left adrenal tumor. Conn's syndrome was diagnosed, for which laparoscopic adrenalectomy is now the therapy of choice. This case was complicated by an ipsilateral ectopic pelvic kidney. A laparoscopic left adrenalectomy was performed via a lateral transabdominal approach. Without the usual anatomic landmark of the ipsilateral kidney, the left adrenal gland was difficult to identify, so intraoperative ultrasound was used to locate the lesion. Postoperatively, the patient's blood pressure and potassium normalized. This is the first documented report of a laparoscopic adrenalectomy performed for adrenal adenoma with the anatomic disruption of an ipsilateral pelvic kidney.

Endoscopic marking: an adjunct to laparoscopic gastrointestinal surgery.

BACKGROUND: In 1975 one of us (J.P.) first described endoscopic marking of the intestinal lumen with india ink to produce a serosal tattoo, thus facilitating the location of lesions during subsequent surgery. The use of the technique in concert with laparoscopic surgery is particularly important because the ability to palpate the bowel is lost. Carbon-based products such as india ink provide permanent marking. An alternative marker is methylene blue, whose mark is only temporary but clearly seen laparoscopically. METHODS: We have used methylene blue for intraoperative marking, reserving India ink for instances in which marking endoscopy occurs before surgery. RESULTS: 15 patients, over a period of 2 years, had endoscopic marking performed preoperatively or intraoperatively. All markings were easily visualized upon laproscopy, assisting identification of the sites of the lesions. Numerous other cases were marked at endoscopy but did not come to surgery. CONCLUSION: Endoscopic marking is an invaluable tool in the performance of laparoscopic gastrointestinal surgery.

Ambulatory laparoscopic surgery.

Laparoscopic procedures are becoming routine and commonplace. Patients who undergo laparoscopic surgery enjoy shorter hospital stays and quicker recovery times. These procedures have naturally progressed to an ambulatory status. Their spectrum is continually expanding. Also, the trend towards shorter hospital stays, in part driven by the advent of laparoscopic procedures, may alter traditional surgical dogma regarding length of stay.