title: Clipless and sutureless laparoscopic surgery for adrenal and extra-adrenal tumors.
abstract: BACKGROUND
  Newer, energy-based devices like the ultrasonic coagulator (Harmonic Scalpel, Ethicon Endo-Surgery, Inc., Cincinnati, OH) and the LigaSure vessel-sealing system (Valleylab, Boulder, CO) are increasingly being used in advanced laparoscopic procedures. Use of these devices has resulted in shorter operative time, less blood loss, and lower conversion rates. We present our experience with these devices for laparoscopic removal of adrenal and extra-adrenal tumors.
  
  
  METHODS
  Ten patients with adrenal tumors and 4 with extra-adrenal tumors were operated on laparoscopically with the ultrasonic shears and LigaSure vessel-sealing system. The entire surgery was carried out using these energy-based devices without using any clips or sutures.
  
  
  RESULTS
  No conversions were necessary. None of the patients experienced any major intraoperative or postoperative bleeding. The mean size of the tumor was 6.2 cm (range, 3 to 8). The mean operative time was 123 minutes (range, 80 to 210), and the mean blood loss was 70 mL (range, 10 to 150). Histopathology revealed pheochromocytomas in 7 patients.
  
  
  CONCLUSIONS
  Use of the LigaSure vessel-sealing device along with ultrasonic shears for laparoscopic removal of adrenal and extra-adrenal tumors is safe and effective.
authors.affiliation: Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. mcmisra@gmail.com
authors.forename: Mahesh Chandra
authors.initials: MC
authors.lastname: Misra
authors.forename: Sandeep
authors.initials: S
authors.lastname: Aggarwal
authors.forename: Sandeep
authors.initials: S
authors.lastname: Guleria
authors.forename: Vulatheru
authors.initials: V
authors.lastname: Seenu
authors.forename: Amar Pal
authors.initials: AP
authors.lastname: Bhalla