Laparoscopic Single-Incision Triangulated Umbilical Surgery Adrenalectomy for Large (>5 cm) Tumors of the Adrenal Gland: Initial Experience with 16 Cases

Figure 1

Schematic diagram of the left SITUS incision. (a) Patient’s position: the patient was positioned in a standard 70° recumbent position, padding the waist high. The incision line was made on the abdominal wall and serrated notches were added to increase the tension of the outer rim. (b) A cut was made along the line as shown. The skin and subcutaneous tissues were then removed. The arc back of the umbilicus incision was oriented toward the operation field. (c) A trocar was inserted into the viewport at the midpoint of the C-shaped incision as far as possible from the umbilicus. The right-hand operative port was moved vertically down the viewport as low as possible. (d) The left-hand operative port was then placed at the highest position of the midline of the torso. (e) Diagrammatic sketch showing the relationship between the incision, the trocars, and the tumor. (f) The viewport and the right-hand operative port were then connected and the sides were drawn out to remove the specimen. (g–j) show how the incision was sutured. The side incisions around the C-shaped main incision were made by removing the skin and subcutaneous tissue between the paired points A and A1, B and B1, and so on; this widened the distance between these ports. The increased serrated side incision could also be sutured into the umbilicus by suturing the subcutaneous tissue by the rule of suturing three points—A, A1, and a—together (h, i), thus forming a single point (A) as shown. The skin between these points (A–H) was then sutured intradermally with VICRYLTM Rapide (ETHICON).

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