Adrenal Solitary Fibrous Tumor: A Case Report.

Solitary fibrous tumor is a mesenchymal neoplasm that first appeared in the literature as a pleural lesion, but over the last decades, it has been reported in many extrathoracic sites. Primary solitary fibrous tumor in the adrenal gland is very uncommon. Its biological behavior is variable but mostly benign. We report here a case of an apparently healthy woman who, in the context of the study of limb paresthesias, was diagnosed with an adrenal incidentaloma. Laboratory tests were performed, and no hormone hyperfunction was detected. Subsequently, a right adrenalectomy was performed, and the pathological study confirmed a solitary fibrous tumor. To the best of our knowledge, this is the 19th case reported in the literature of a primary solitary fibrous tumor originating from the adrenal gland and, notably, the first documented instance in Spain.

Suprarrenalectomía retroperitoneoscópica por vía posterior. Recomendaciones para la implementación de esta técnica / Posterior retroperitoneoscopic adrenalectomy: recommendations to implement this approach

Introducción: El abordaje retroperitoneoscópico posterior es una técnica poco extendida en España para la suprarrenalectomía a pesar de que, según algunos autores, ofrece ventajas respecto al acceso laparoscópico anterior o lateral. El objetivo del estudio fue identificar aquellas características que permitieran seleccionar los casos más favorables para iniciarse en esta técnica. Métodos: Estudio observacional de una cohorte de 50 pacientes intervenidos mediante suprarrenalectomía retroperitoneoscópica posterior (SRP) en un único centro. Se evaluó: sexo, edad e índice de masa corporal (IMC), tiempo operatorio, lateralidad, tamaño y características anatomopatológicas de las lesiones, tasa de conversión, complicaciones y estancia hospitalaria. Resultados: Se intervinieron 25 (50%) mujeres y 25 (50%) hombres con un tiempo operatorio mediano de 80 minutos (45-180). Se observó un tiempo operatorio significativamente menor en mujeres (p = 0,002) y en adenomas (p = 0,002). En cambio, no se observó correlación entre el tiempo quirúrgico e IMC, lateralidad o tamaño de la lesión. No hubo ningún caso de conversión. Las complicaciones fueron del 14% y la mayoría fueron leves, según la Escala de Clavien Dindo (i). La estancia hospitalaria mediana fue de dos días. Conclusiones: La suprarrenalectomía retroperitoneoscópica por vía posterior es una técnica segura, reproducible y con muy buenos resultados. Los casos más favorables para iniciar la implantación de este abordaje son mujeres con adenomas suprarrenales. (AU)

Introduction: The posterior retroperitoneoscopic approach (PRA) is seldom used in our country to perform adrenalectomies, although it offers possible advantages over laparoscopic anterior or lateral access, according to some authors. The aim of this study was to identify those features that determine the most suitable cases to start the implementation of this technique. Methods: A prospective observational study was performed with a 50 patients cohort. All the cases were operated using the PRA. Sex, age, body mass index (BMI), operative time, left or right side, size and anatomopathological characteristics of the lesion, conversion rates, complications and hospital stay were analyzed. Results: 25 (50%) women and 25 (50%) men underwent surgery, with a median operative time of 80 minutes (45-180). A significantly shorter operative time (p = 0.002) was observed in women and in adenomas (p = 0.002). However, no correlation was observed between surgical time and BMI, lesion side or lesion size. There were no conversions. The complication rate was 14%, and most of the complications were grade i in Clavien Dindo's Scale. Median hospital stay was two days. Conclusions: Retroperitoneoscopic adrenalectomy by posterior approach is a safe and reproducible procedure, with very good outcomes. The most suitable cases to implement this technique would be female patients with adrenal adenomas. (AU)

Posterior retroperitoneoscopic adrenalectomy: recommendations to implement this approach. / Suprarrenalectomía retroperitoneoscópica por vía posterior. Recomendaciones para la implementación de esta técnica.

INTRODUCTION: The posterior retroperitoneoscopic approach (PRA) is seldom used in our country to perform adrenalectomies, although it offers possible advantages over laparoscopic anterior or lateral access, according to some authors. The aim of this study was to identify those features that determine the most suitable cases to start the implementation of this technique. METHODS: A prospective observational study was performed with a 50 patients cohort. All the cases were operated using the PRA. Sex, age, body mass index (BMI), operative time, left or right side, size and anatomopathological characteristics of the lesion, conversion rates, complications and hospital stay were analyzed. RESULTS: 25 (50%) women and 25 (50%) men underwent surgery, with a median operative time of 80 minutes (45-180). A significantly shorter operative time (p = 0.002) was observed in women and in adenomas (p = 0.002). However, no correlation was observed between surgical time and BMI, lesion side or lesion size. There were no conversions. The complication rate was 14%, and most of the complications were grade i in Clavien Dindo's Scale. Median hospital stay was two days. CONCLUSIONS: Retroperitoneoscopic adrenalectomy by posterior approach is a safe and reproducible procedure, with very good outcomes. The most suitable cases to implement this technique would be female patients with adrenal adenomas.

Really Totally Robotic SADI-S in a Patient with Extreme Morbid Obesity and Non-Reducible Umbilical Hernia: Case Report.

BACKGROUND: Single anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-s) is a well-known and accepted technique for extreme obesity but technically challenging in this group of patients and so frequently is performed as a laparoscopic staged procedure. Robotic devices such as Da Vinci® system may solve some limitations of laparoscopic surgery. The video shows a really totally robotic SADI-s (RTR-SADI-s) in a single stage on a patient with extreme morbid obesity and a non-reducible umbilical hernia. METHODS: A 56-year-old female patient with BMI = 58 kg/m2 and a large non-reducible umbilical hernia was planned for a RTR-SADI-s. A Da Vinci Xi® model was used and neither laparoscopic assistance nor change of surgical table position was needed. RESULTS: The patient was in 20° reverse Trendelenburg position during all the procedure, with open legs and arms in complete adduction. All trocars were robotic. After the umbilical hernia reduction, a 300-cm ileal loop was measured and temporarily attached to the right hypochondrium peritoneum. The gastric sleeve was performed 6 cm from the pylorus over a 36Fr bougie. A robotic hand-sewn four-layer duodenoileal anastomosis was performed with barbed absorbable sutures. Docking time was 8 min. Total operative time was 240 min, of which 165 min corresponded to the SADI-s procedure and 75 min to the reduction and reparation of the umbilical hernia. There were no complications during or after surgery, and the patient was discharged on the third postoperative day. CONCLUSIONS: Robotic platforms can significantly minimize the difficulty of bariatric surgery, allowing one-stage procedures in patients with extreme obesity that could require two-stage procedures in a laparoscopic approach.