title: Preoperative virtual simulation of adrenal tumors.
abstract: BACKGROUND
  Retroperitoneal endoscopic adrenalectomy (EA) is recognized as a principal procedure for benign adrenal tumors. However, a limited visual field and a narrow working space make this approach difficult, particularly in cases of obese patients or small tumors. Using multidetector row CT (MD-CT), this study investigated the use of preoperative virtual simulation (PVS) to identify tumor and central vein locations for EA, and verified these findings during EA surgery.
  
  
  METHODS
  The study enrolled 11 cases comprising 10 adrenal adenomas and one ACTH-independent macronodular adrenal hyperplasia admitted to Jichi Medical University Hospital, Tochigi, Japan, between November 2003 and October 2006. Patients were evaluated in a lateral bending position using MD-CT. 3D PVS images of ribs, vertebrae, kidneys, and adrenal tumors were generated and compared with real images obtained during EA.
  
  
  RESULTS
  The PVS images clearly showed the relative locations of the adrenal tumor, kidney, and adjacent anatomical structures. These locations were verified during EA. The central vein was identified in the PVS images in all cases. Information derived from the PVS images assisted in the performance of EA surgery.
  
  
  CONCLUSIONS
  Preoperative 3D-simulation images using MD-CT contributed to the safety and efficiency of performing EAs.
authors.affiliation: Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan. shiozawa@jichi.ac.jp
authors.forename: Mikio
authors.initials: M
authors.lastname: Shiozawa
authors.forename: Naohiro
authors.initials: N
authors.lastname: Sata
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Endo
authors.forename: Masaru
authors.initials: M
authors.lastname: Koizumi
authors.forename: Yosikazu
authors.initials: Y
authors.lastname: Yasuda
authors.forename: Hideo
authors.initials: H
authors.lastname: Nagai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takakusaki
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000315:Adrenalectomy; D018246:Adrenocortical Adenoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014584:User-Computer Interface