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array:23 [ "pii" => "S2173578621001165" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2021.04.013" "estado" => "S300" "fechaPublicacion" => "2021-12-01" "aid" => "1375" "copyright" => "AEU" "copyrightAnyo" => "2021" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2021;45:609-14" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210480621000863" "issn" => "02104806" "doi" => "10.1016/j.acuro.2021.04.002" "estado" => "S300" "fechaPublicacion" => "2021-12-01" "aid" => "1375" "copyright" => "AEU" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2021;45:609-14" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artículo original</span>" "titulo" => "Suprarrenalectomía retroperitoneoscópica por puerto único: experiencia inicial y estandarización de la técnica" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "609" "paginaFinal" => "614" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Single-port retroperitoneoscopic adrenalectomy: Initial experience and standardization of the technique" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2508 "Ancho" => 2508 "Tamanyo" => 989448 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">a) Se visualizan fascia de Zuckerkandl abierta (Z) y posteriormente polo renal superior (R). b) Control de vena suprarrenal (v). Masa suprarrenal (S). c) TC de paciente con IMC<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> y lesión mayor de 5<span class="elsevierStyleHsp" style=""></span>cm (en rojo). d) Feocromocitoma suprarrenal.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Vazquez-Martul, M.A. García-Expósito, S. Rodríguez-Rey, R. García-Sobrino, A. Barbagelata-López, J.L. Ponce Díaz-Reixa, V. Chantada-Abal" "autores" => array:7 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Vazquez-Martul" ] 1 => array:2 [ "nombre" => "M.A." "apellidos" => "García-Expósito" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Rodríguez-Rey" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "García-Sobrino" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Barbagelata-López" ] 5 => array:2 [ "nombre" => "J.L." "apellidos" => "Ponce Díaz-Reixa" ] 6 => array:2 [ "nombre" => "V." "apellidos" => "Chantada-Abal" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173578621001165" "doi" => "10.1016/j.acuroe.2021.04.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578621001165?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480621000863?idApp=UINPBA00004N" "url" => "/02104806/0000004500000010/v1_202112020826/S0210480621000863/v1_202112020826/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173578621001219" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2021.02.009" "estado" => "S300" "fechaPublicacion" => "2021-12-01" "aid" => "1364" "copyright" => "AEU" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2021;45:615-22" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Utility of preoperative vascular embolization of renal tumors with left renal vein tumor thrombus" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "615" "paginaFinal" => "622" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de la embolización vascular prequirúrgica de tumores renales con trombo tumoral en la vena renal izquierda" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2709 "Ancho" => 2508 "Tamanyo" => 426320 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Tumor thrombus extending past the aorta; (B) tumor thrombus extending into the inferior vena cava; (C) tumor thrombus with sufficient space for vascular control between the proximal end of the tumor thrombus and the aorta.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Caño Velasco, L. Polanco Pujol, F. Herranz Amo, J. González García, J. Aragón Chamizo, C. Hernández Fernández" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Caño Velasco" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Polanco Pujol" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Herranz Amo" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "González García" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Aragón Chamizo" ] 5 => array:2 [ "nombre" => "C." "apellidos" => "Hernández Fernández" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480621000437" "doi" => "10.1016/j.acuro.2021.02.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480621000437?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578621001219?idApp=UINPBA00004N" "url" => "/21735786/0000004500000010/v1_202112020948/S2173578621001219/v1_202112020948/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Single-port retroperitoneoscopic adrenalectomy: Initial experience and standardization of the technique" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "609" "paginaFinal" => "614" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "D. Vazquez-Martul, M.A. García-Expósito, S. Rodríguez-Rey, R. García-Sobrino, A. Barbagelata-López, J.L. Ponce Díaz-Reixa, V. Chantada-Abal" "autores" => array:7 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Vazquez-Martul" "email" => array:1 [ 0 => "dario.vazquez-martul.pazos@sergas.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M.A." "apellidos" => "García-Expósito" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Rodríguez-Rey" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "García-Sobrino" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Barbagelata-López" ] 5 => array:2 [ "nombre" => "J.L." "apellidos" => "Ponce Díaz-Reixa" ] 6 => array:2 [ "nombre" => "V." "apellidos" => "Chantada-Abal" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Suprarrenalectomía retroperitoneoscópica por puerto único: experiencia inicial y estandarización de la técnica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2508 "Ancho" => 2508 "Tamanyo" => 660814 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Anatomic landmarks, tip of 12th rib (12), iliac crest (cr) and paraspinal musculature (m); subcostal incision of 3–4 cm (dotted line). (b and c) Placement of multichannel port once we accessed the posterior pararenal space. (d) Final cosmetic outcome following surgery.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction and objective</span><p id="par0005" class="elsevierStylePara elsevierViewall">Since the first laparoscopic adrenalectomy performed in 1992 by Gagner et al., this approach has been increasingly consolidating and is currently the most widely used in the treatment of adrenal gland disorders.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Due to the anatomical location of the gland, a purely extraperitoneal approach using minimally invasive techniques is also possible with results comparable to transperitoneal access. However, it seems to be less widespread, partly due to its potential technical limitations, such as a narrower working space, or fewer anatomical landmarks.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Single-port retroperitoneal surgery (SPORS) in the treatment of the adrenal gland is</p><p id="par0020" class="elsevierStylePara elsevierViewall">even less frequent, although it could regain strength in the future with the new robotic platforms.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> To date, the complexity in the implementation of this approach makes its use currently very limited, practically nonexistent in European countries.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Our aim is to provide initial results from our center, as well as data on the feasibility of SPORS for the treatment of adrenal disease, in the first consecutive and standardized series in our country.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">We performed a retrospective study of the first consecutive cases undergoing treatment for adrenal disease using SPORS, performed by the same surgeon, between December 2018 and August 2020.</p><p id="par0035" class="elsevierStylePara elsevierViewall">We analyzed sex, age, body mass index (BMI), intraoperative bleeding, operative time, specimen size (maximum diameter), length of hospital stay, postoperative pain using visual analog scale (VAS), histopathological findings and presence of surgical complications according to Clavien-Dindo scale.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Description of the technique</span><p id="par0040" class="elsevierStylePara elsevierViewall">All interventions were performed through a single 3−4 cm incision made approximately 1 cm beneath the tip of the ipsilateral 12th rib, to allow access to the posterior pararenal space. This was followed by the creation of the retroperitoneal space with a Gaur’s balloon, and the placement of the multichannel working port (Sejong Medical, Sejong, South Korea) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a–c).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">For the performance of the procedure, we used a 30° videoscope, curved forceps in the surgeon's left hand (Karl Storz, Tullingem, Germany) and conventional straight instruments in the right hand in order to maintain the principles of laterality and triangulation. LigaSure Bluntip sealer (Medtronic, MN, USA) was used in all interventions. In all cases, the procedure was performed with the patient in a lateral decubitus position (contralateral to the affected gland) using insufflation pressures of 12 and 15 mmHg.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The key surgical steps reproduced those of the conventional retroperitoneoscopic approach: opening of the posterior renal fascia (Zuckerkandl’s fascia), identification of the upper pole of the kidney and the medial adrenal gland, dissection and control of the adrenal pedicle, dissection and division of the adrenal mass, and removal of the surgical specimen in a retrieval bag (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>a–b). We avoided the use drainage in almost all cases. The final closure of the incision is performed with surgical staples or intradermal suture (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>d).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">A total of 4 women and 2 men with a mean age of 68 years (range 37–76 years) and a mean BMI of 30.2 kg/m<span class="elsevierStyleSup">2</span> (range 22−38 kg/m<span class="elsevierStyleSup">2</span>) underwent surgery.</p><p id="par0060" class="elsevierStylePara elsevierViewall">All interventions were performed without requiring additional trocar placement or conversion to open surgery. Intraoperative bleeding did not exceed 150 ml in any case, being in most cases less than 100 ml (range 20−150 ml). It was decided to leave a safety drainage only in one case (patient with a diagnosis of pheochromocytoma and oral anticoagulation) with removal in less than 24 h.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The characteristics of the cases are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Postoperative pain was VAS ≤ 3 (median 0.5) in all cases, managed with oral analgesics; only one case required rescue with intravenous analgesia. No case required transfusion of blood products, nor was any type of complication recorded according to the Clavien-Dindo scale. Surgical margins were negative in all pathological evaluations.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">The challenges and technical implications in the minimally invasive approach to the adrenal gland are associated to tumor size, hemorrhage control and tumor involvement. Currently, the standard approach to adrenal gland pathology has not been clearly established, and recommendations are heterogenous, depending on the disease to be treated. However, the most widely used approach for adrenal pathologies is minimally invasive surgery,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> mainly transperitoneal or robot-assisted laparoscopy. Open surgery is still recommended by a number of publications and clinical guidelines for the approach to certain adrenal carcinomas, due to the risk of peritoneal carcinomatosis among other possible complications, but the incidence of this subtype of lesions within adrenal neoplasms is relatively low.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7–9</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">There is also certain variability among the professionals who treat this pathology. They are not always urologists, which can affect the selection of the approach and technique to be used in each center, in relation to the routine surgical practice and knowledge of the access route. The retroperitoneoscopic approach, more common in urology, does not seem to be the most widely used. However, certain studies and reviews indicate results comparable to those of the transperitoneal approach, and in some cases, certain advantages such as shorter operative time or less pain and postoperative stay, the latter being in accordance with the findings of the comparative study by Maurice et al. in relation to partial nephrectomies.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–12</span></a> We should also keep in mind that the retroperitoneoscopic approach can be performed with the patient in the prone (jackknife) or lateral decubitus position, the latter being used in our center and by most surgeons in our country. There are no data in the literature specifying clear differences based on the patient's position, and these may be limited to the surgeon’s ergonomics and the corresponding anesthetic implications.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Currently, there are very few publications describing consecutive series of retroperitoneoscopic single-port (SP) adrenalectomy, generally restricted to small masses and mostly centered on the Asian continent; some of them are based on limited experience and with non-specific SP surgical instrumentation.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">We must keep in mind that this technique may not be widely reproducible by all surgeons and centers. However, in our opinion, it is a further evolution in minimally invasive surgery, as it initially reduces the number of incisions and accesses from 3 to 5 to only one, although the lack of prospective and randomized studies does not allow us to conclusively shed light on the potential advantages, beyond the obvious cosmetic benefit and a possible reduction in postoperative pain.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Nevertheless, we should not forget that this type of SP approach is emerging as an evolution and a firm commitment of the new robotic platforms.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,15,16</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">It has also been observed that the quality of life in patients treated with transperitoneal SP adrenal surgery appears to be superior to that of patients undergoing laparoscopic surgery with multiple ports, as reported in a recent publication.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Our initial experience, although still limited, has allowed us to extend this approach in an almost systematical way, even in cases of high complexity due to tumor size, high BMI or other adverse features of the patients, such as previous anticoagulant treatment (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>c–d). According to our criteria and with the initial results, we believe that it is the first-line approach in the treatment of adrenal gland disease, except for cases of clear contraindications or manifested complexity. We must not forget that the possibility of placing accessory trocars, or converting to conventional retroperitoneoscopy is an ever present option, although it has not been required in any case in our initial series.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Our data support what has been previously informed in the literature, including a low level of postoperative pain (VAS) without intravenous analgesia requirements in practically all cases, accompanied by an optimal cosmetic result, as well as the intrinsic benefits of the extraperitoneal approach by avoiding the violation and manipulation of the intraperitoneal space and organs. The data on postoperative length of stay and intraoperative bleeding are excellent, while it maintains, in our opinion, competitive operative times considering that this is an initial series, and without observing to date any type of complication quantifiable by means of the Clavien-Dindo scale.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0105" class="elsevierStylePara elsevierViewall">For the treatment of adrenal pathology, even in complex cases, SPORS is a feasible, reproducible and safe technique with very good cosmetic results and minimal postoperative pain.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1620095" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1446842" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1620094" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1446841" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction and objective" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Description of the technique" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-11-11" "fechaAceptado" => "2021-04-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1446842" "palabras" => array:5 [ 0 => "Adrenal" 1 => "Adrenalectomy" 2 => "Retroperitoneoscopy" 3 => "Single-port" 4 => "LESS" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1446841" "palabras" => array:5 [ 0 => "Suprarrenal" 1 => "Suprarrenalectomía" 2 => "Retroperitoneoscopia" 3 => "Puerto único" 4 => "LESS" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The minimally invasive surgical approach to adrenal gland pathology is the most widely used nowadays, and retroperitoneoscopy occupies a relevant place. However, the evolution of these techniques towards even less invasive surgery through single-port access is anecdotal. The aim of this work is to describe our initial experience in single-port retroperitoneoscopic surgery (SPORS) of the adrenal gland focusing on perioperative data and postoperative pain.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We collected and analyzed the demographic and operative data of a series of patients undergoing adrenalectomy through SPORS. All procedures were performed through a single 3−4 cm subcostal incision with a multichannel port. Surgical data such as operative time, bleeding, length of stay and presence of complications were collected. We used the visual analog scale (VAS) for postoperative pain assessment.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">From December 2018 to August 2020, 6 patients with different types of adrenal pathology underwent consecutive surgeries in our Department by the same surgeon using SPORS. All surgeries were performed without requiring accessory trocar placement or reconversion to open surgery. The mean operative time was 91.6 ± 16.3 min, with <150 mL bleeding, mean length of stay of 35.8 ± 13.3 h and postoperative pain of VAS ≤3 (median 0.5). The mean size of specimens was 57.8 ± 18 mm. No complications were reported according to the Clavien-Dindo scale.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Even in initially adverse cases, SPORS adrenalectomy is a feasible and safe technique with good cosmetic and perioperative results.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción y objetivo</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El abordaje mediante cirugía mínimamente invasiva de la patología de la glándula suprarrenal es el más extendido hoy en día, en donde la retroperitoneoscopia ocupa un lugar a tener muy en cuenta; sin embargo, la evolución de estas técnicas hacia abordajes todavía menos invasivos a través de puerto único es anecdótica.</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La finalidad de este trabajo es describir nuestra experiencia inicial en cirugía retroperitoneoscópica por puerto único (SPORS) de la glándula suprarrenal centrándonos en los datos perioperatorios y dolor postoperatorio.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Recogimos y analizamos los datos demográficos y operatorios de una serie de pacientes tratados mediante suprarrenalectomía mediante SPORS. Todos los procedimientos se realizaron mediante una única incisión subcostal de 3−4 cm a través de un puerto multicanal. Se recogen diferentes datos quirúrgicos como tiempo operatorio, sangrado, estancia o presencia de complicaciones. Empleamos la escala visual analógica (EVA) para la valoración del dolor postoperatorio.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Entre diciembre del 2018 y agosto del 2020, 6 pacientes con diferentes patologías suprarrenales fueron intervenidos en nuestro Departamento de forma consecutiva por el mismo cirujano mediante SPORS. Todas las cirugías se realizaron sin requerir colocación de trocares accesorios o reconversión a cirugía abierta. El tiempo medio de las intervenciones fue de 91,6 ± 16,3 min, con un sangrado <150 ml, una estancia media de 35,8 ± 13,3 h y un dolor postoperatorio analizado EVA ≤ 3 (mediana de 0,5). El tamaño medio de las piezas fue de 57,8 ± 18 mm. No se reportó ninguna complicación según la escala Clavien-Dindo.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La suprarrenalectomía mediante SPORS es una técnica factible y segura incluso en casos inicialmente adversos con buenos resultados cosméticos y perioperatorios.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vazquez-Martul D, García-Expósito MA, Rodríguez-Rey S, García-Sobrino R, Barbagelata-López A, Ponce Díaz-Reixa JL, et al. Suprarrenalectomía retroperitoneoscópica por puerto único: experiencia inicial y estandarización de la técnica. Actas Urol Esp. 2021;45:609–614.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2508 "Ancho" => 2508 "Tamanyo" => 660814 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Anatomic landmarks, tip of 12th rib (12), iliac crest (cr) and paraspinal musculature (m); subcostal incision of 3–4 cm (dotted line). (b and c) Placement of multichannel port once we accessed the posterior pararenal space. (d) Final cosmetic outcome following surgery.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2508 "Ancho" => 2508 "Tamanyo" => 989448 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(a) Open Zuckerkandl's fascia (Z) and posterior superior renal pole (R) are visualized. (b) Adrenal vein control (v). Adrenal mass (S). (c) CT scan of patient with BMI > 35 kg/m<span class="elsevierStyleSup">2</span> and lesion larger than 5 cm (in red). (d) Adrenal pheochromocytoma.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">PA: pathological anatomy; VAS: visual analog scale; GAPP: Grading System for Adrenal Pheochromocytoma and Paraganglioma; M: male; h: hours; BMI: body mass index; F: female; ml: milliliters; mm: millimeters; min: minutes.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BMI (kg/m<span class="elsevierStyleSup">2</span>) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Op. time (min) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Bleeding (ml) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Size (mm) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Length of hospital stay (h) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">VAS \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PA \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">H \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">140 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 × 30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mature teratoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 × 26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adenoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">120 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55 × 30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adenoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">H \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85 × 60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pheochromocytoma (GAPP 4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55 × 28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adenoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">150 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 × 55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pheochromocytoma (GAPP 5) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2760701.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Demographic and surgical data.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. 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