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Operations are done with an high definition 3D laparoscopic system (Olympus, Tokyo, Japan); all personnel wear polarized glasses to achieve stereoscopic imaging in the operating room. Dissection is realized using a hybrid energy system (Thunderbeat, Olympus Europe Se \& Co, Hamburg, Germany).

José Ignacio Rodríguez-Hermosa, MD, PhD

The main drawbacks of conventional 2D laparoscopy are limited depth perception and loss of spatial orientation. High-quality 3D laparoscopy systems might improve surgical outcomes for adrenalectomy.

Over recent decades, technological advances such as improved video imaging (high-definition cameras), better instrumentation for dissection and hemostasis, articulating staplers, and optimized operating room lighting have added safety, efficacy, and precision to minimally invasive procedures. However, until recently, laparoscopy required surgeons to operate in a three-dimensional (3D) space with only two-dimensional (2D) images to guide their movements, resulting in a lack of depth perception and loss of spatial orientation that increased the risk of errors, fatigue, operative time, and operating room stress and made the technique difficult to learn.

High-quality 3D laparoscopy was developed as an alternative to conventional 2D laparoscopy. Several clinical trials and observational studies have compared surgical outcomes between 2D and 3D laparoscopic systems; however, few clinical studies have examined the usefulness of 3D laparoscopy systems for adrenalectomies.

3D Laparoscopic Adrenalectomies for Adrenal Tumors

Three-dimensional Laparoscopic Adrenalectomies for Benign and Malignant Adrenal Tumors

Rate of medical and surgical complications within 30 days after surgery using the Dindo-Clavien classification, described as:

Grade I = Any deviation from the normal postoperative course. Grade 2 = Requiring pharmacological treatment with drugs other than such allowed for grade I complications.

Grade III = Requiring surgical, endoscopic or radiological intervention, not under (Grade IIIa) or under general anesthesia (Grade IIIb) Grade IV = Life-threatening complication with single organ (Grade IVa) or Multiorgan dysfunction (Grade IVb) Grade V = Death of a patient.

Total length of hospital stay will be recorded in days beginning at admission for surgery until discharge (number of days) .

Use of abdominal drainage intraoperatively (Yes vs No).

ASA I A normal healthy patient ASA II A patient with mild systemic disease ASA III A patient with severe systemic disease ASA IV A patient with severe systemic disease that is a constant threat to life ASA V A moribund patient who is not expected to survive without the operation ASA VI A declared brain-dead patient whose organs are being removed for donor purposes

Adrenal mass \<6 cm, Adrenal mass ≥6 cm

Incidentaloma, Aldosteronoma, Pheochromocytoma, Cushing's Adenoma and malignant adrenal tumors (primary or metastasis)

Conversion (Yes vs No), operative time (min), bleeding (ml), Clavien-Dindo Classification

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
3D Laparoscopic Adrenalectomies for Adrenal Tumors	NCT04905706	Adrenal Tumor Adrenalectomy; ...		18 Years -	Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta
3D Laparoscopic Adrenalectomies for Adrenal Tumors	NCT04905706	Adrenal Tumor Adrenalectomy; ...		18 Years -	Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta

Spots Global Cancer Trial Database for 3d laparoscopic adrenalectomy