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Resumen Introduccion La lesion de via biliar continua siendo una de las complicaciones mas graves tras la colecistectomia. El objetivo de este estudio es mostrar una tecnica sencilla para la administracion del verde de indocianina intravesicular, consiguiendo una vision critica optima durante la colecistectomia laparoscopica. Metodos Se estudiaron prospectivamente 23 pacientes con administracion intravesicular de verde de indocianina con aguja fina utilizando una tecnica facilmente reproducible. Resultados Se reporto la vision de las estructuras biliares antes y despues de su administracion. La vision critica de seguridad se consiguio en todos los casos. Conclusiones La administracion intravesicular de verde indocianina mediante la tecnica que describimos es sencilla, efectiva y consigue una colangiografia por fluorescencia en tiempo real y una vision critica de seguridad optima, disminuyendo asi el riesgo de lesion biliar.

Introduction Bile duct injury is one of the most severe complications after cholecystectomy. The aim of this study is to demonstrate how with a simple technique, an optimal critical view may be achieved by injecting indocyanine green directly into the gallbladder. Methods Twenty-three patients were prospectively studied in which direct gallbladder injection of indocyanine green during laparoscopy was administered with a fine needle using an easily reproducible technique. Results Biliary tree identification was reported before and after injection. Critical view of safety was achieved in all cases. Conclusions Our technique of direct gallbladder injection of indocyanine green is simple, efficient and shows a real time fluorescent cholangiography and an optimal critical view of safety decreasing the risk for bile duct injury.

Resumen Introduccion La adrenalectomia con preservacion cortical se indica como tratamiento del feocromocitoma bilateral hereditario y esporadico, en casos de bajo riesgo de malignidad, para reducir la posibilidad de insuficiencia suprarrenal asumiendo la eventualidad de una recidiva local. El objetivo del estudio es analizar los resultados funcionales de la adrenalectomia parcial por via endoscopica retroperitoneal en pacientes monoadrenales o que necesiten una adrenalectomia bilateral. Metodos Entre enero de 2015 y febrero de 2016 se incluyeron de forma prospectiva pacientes con feocromocitoma asociado a mutaciones con bajo riesgo para malignidad, que aceptaron participar en el estudio. Todos fueron operados por cirujanos especialmente entrenados en este tipo de cirugia, utilizando la misma tecnica quirurgica. Se recogieron variables demograficas y caracteristicas clinicas, realizando posteriormente el analisis descriptivo de dichas variables. Resultados Se registraron un total de 6 pacientes, cuatro asociados al sindrome MEN tipo 2 y dos en contexto del sindrome VHL. No fue precisa ninguna conversion a abordaje laparoscopico o abierto y tampoco complicaciones postoperatorias, la estancia hospitalaria media fue de 2,5 dias. Se logro la preservacion de corteza adrenal funcionante sin requerimiento corticoideo en 5 (83%) de 6 casos. Con un seguimiento medio de 26,2 ± 6 meses, estos 5 pacientes presentan una funcion adrenal conservada sin aporte hormonal sustitutivo. Conclusiones La adrenalectomia con preservacion cortical por via endoscopica retroperitoneal, en manos expertas, es segura y factible para el tratamiento del feocromocitoma hereditario y esporadico en contexto de baja malignidad, permitiendo evitar la necesidad de aporte corticoideo en la mayoria de los casos.

Introduction Cortical-sparing adrenalectomy is a suitable treatment for hereditary and sporadic bilateral pheochromocytoma, in cases of low risk of malignancy, to reduce the possibility of adrenal insufficiency assuming the chance of local recurrence. The aim of the study is to analyze the functional results of partial adrenalectomy by retroperitoneal endoscopic approach in single-adrenal patients or patients requiring bilateral adrenalectomy. Methods Prospective study between January 2015 and February 2016 including pheochromocytoma patients diagnosed with low risk of malignant mutations. All patients agreed to be included in the study. Experienced endocrine surgeons who have been trained in minimally invasive endocrine surgery performed the procedure using the same surgical technique. Demographic variables and clinical characteristics were collected, subsequently carrying out the descriptive analysis of the data. Results A total of 6 patients were registered, four associated with MEN type 2 syndrome and two in the context of VHL syndrome. Retroperitoneoscopic resection was performed without laparoscopic or open conversion and no postoperative complications; the average hospital stay was 2.5 days. Preservation of the functional cortex without corticosteroids was achieved in 5 (83%) of out 6 cases with a follow-up of 26.2±6 months. Today, these 5 patients have a preserved adrenal function without hormone replacement. Conclusions Cortical-sparing adrenalectomy by the retroperitoneal endoscopic approach, in expert hands, is safe and feasible for the treatment of hereditary and sporadic pheochromocytoma in a context of low malignancy, making it possible to avoid the need for corticoid replacement in most cases.

Adrenocortical carcinomas are rare and aggressive tumors. The recently described oncocytic subtype has been reported approximately 40 times in the literature.1 In this video, we describe an unusual case of a large adrenal oncocytic carcinoma, its minimally invasive approach, and its anatomopathological features. A 43-year-old male presented to the emergency room with acute abdominal pain and fever. Blood tests showed 20,000 white blood cells and a reactive C-protein of 25. Tomography showed a large right adrenal tumor with necrosis. Antibiotics were started at the intensive care unit. A complete study showed normal tests, including hormones, cortisol, and metanephrines. At the multidisciplinary team meeting it was decided to perform a right transabdominal laparoscopic adrenalectomy. The tumor was approached from the medial side to the lateral side, always controlling the inferior vena cava. Indocyanine green was used to identify vascular structures. Anatomical pathology revealed a 15 cm lesion corresponding to a malignant adrenal oncocytic carcinoma according to the modified Lin–Weis–Bisceglia criteria.2 The patient was discharged without complications on the fifth day. He is receiving mitotane and is disease-free 5 months after surgery. Oncocytic subtype is a rare entity described only a few times in the literature. Surgical treatment is of choice due to its curative potential, and the open versus laparoscopic approach will be chosen depending on the size of the tumor and the surgeon’s experience. It is believed that this subtype may have a less aggressive behavior than the typical adrenal carcinoma,1 therefore its better understanding may help to define therapeutic decisions and prognosis in the future.

The advantages of laparoscopy over open liver resection in patients with cirrhosis have been widely demonstrated. On the other hand, information on the role of minimally invasive liver surgery in the presence of clinically significant portal hypertension (CSPH) is scarce. The aim of this study was to evaluate the role of laparoscopic liver resection in selected cirrhotic patients with CSPH. A retrospective case–control study of cirrhotic patients with hepatocellular carcinoma who were treated with laparoscopic liver resection was conducted from December 2005 to April 2016. A total of 45 patients were included. Patients were divided into two groups according to the presence or absence of clinically significant portal hypertension. Fifteen cirrhotic patients with CSPH were matched with 30 patients without CSPH. Overall, there were no differences in intraoperative results. No conversion to open surgery occurred in the CSPH group, and 3 patients were converted in the Non-CSPH group (0 vs. 10% p = 0.57). Only 2 (7%) patients in the Non-CSPH group and 1 (7%) in the CSPH group had relevant complications (modified Clavien–Dindo classification III). Two patients in the Non-CSPH group and one in the CSPH group developed transient ascites (7 vs. 7%). Postoperative hospital stay was similar in both groups, with a median of 4 days in the CSPH group and 3 days in the Non-CSPH group (p = 0.37). The median follow-up of the entire cohort was 38 months (range 7–100). Overall survival rates at 1 and 3 years were 100 and 87%, respectively. There was no significant difference between the groups in terms of survival (p = 0.8). This initial study showed that laparoscopic resection in patients with CSPH can be performed safely in well-selected patients and expand the current surgical indications in patients with CSPH. Prospective trials with a larger sample size are necessary to confirm these results.