Volume 183, Issue 4, Pages e299-e300 (April 2010)

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Volume 183, Issue 4, Pages e299-e300 (April 2010) V766 SINGLE-PORT RETROPERITONEOSCOPIC ADRENALECTOMY: INITIAL EXPERIENCE AND COMPARATIVE OUTCOMES Xu Zhang, Xin Ma, Hong-zhao Li, Jie Zhu, Tao-ping Shi, Bao-jun Wang, Jiang-ping Gao, Juan Dong The Journal of Urology Volume 183, Issue 4, Pages e299-e300 (April 2010) DOI: 10.1016/j.juro.2010.02.1360 Copyright © 2010 American Urological Association Education and Research, Inc. Terms and Conditions

Figure 1 A. Patient is placed in the full flank position (90°), pressure points are fully padded, the table is flexed, and the patient secured with adhesive tape. Arm boards are used to support the upper extremities in a neutral position. B. Deployed TriPort in a 2.5 cm transverse skin incision along the lower margin of the 12th rib in the midaxillary line with the insufflation channel attached. C. External view during Single-Port Anatomical Retroperitoneoscopic Adrenalectomy (SP-ARA). The working instruments and digital videoscope are seen entering the TriPort. D. Postoperative photograph of 2.5-cm scar at site of port insertion at 10 d following SP-ARA The Journal of Urology 2010 183, e299-e300DOI: (10.1016/j.juro.2010.02.1360) Copyright © 2010 American Urological Association Education and Research, Inc. Terms and Conditions

Figure 2 Internal view of different intraoperative scenarios of SP-ARA. A. Gerota's fascia is incised longitudinally along the posterior peritoneal reflection (white arrows). B. The first dissection plane between the peri-renal fat and the anterior Gerota's fascia (GF) located at the superomedial side of the upper kidney pole (UKP). C. Identifying the adrenal tumor (AT) at the first dissection plane. D. By grasping the peri-adrenal fat cephalad, the bottom of the adrenal gland or tumor is separated from the parenchymal surface of the upper kidney pole. Then the third dissection plane is developed. E. The inferior adrenal vessels located at the lower median aspect of the adrenal gland are transected using the ultrasonic scalpel or clipping. F. The upper adrenal arteries (UAA) are transected. The Journal of Urology 2010 183, e299-e300DOI: (10.1016/j.juro.2010.02.1360) Copyright © 2010 American Urological Association Education and Research, Inc. Terms and Conditions