Laparoscopic and robotic assisted adrenal surgery.

The aim of this paper is to review the current state of laparoscopic and robotic surgery in the mannagement of benign and malignant disease of the adrenal gland. Adrenal lesions can be adenomas, pheochromocytomas, myelolipomas, ganglioneuromas, adrenal cysts, hematomas, adrenal cortical carcinomas, metastases from other cancers, or other rare causes. Laparoscopic adrenalectomy (LA) has become the new standard of care for benign adrenal neoplasms and is being increasingly utilized for malignant disease. Robotic assistance offers unique advantages in visualizing and dissecting the adrenal gland, especially considering its challenging vasculature. Series of robotic adrenalectomy (RA) and LA show that techniques are both safe and effective compared to open. There is also growing evidence in using minimally invasive approaches in adrenal sparing-surgery. Success in these procedures depends on a firm understanding of adrenal anatomy and in careful patient selection. Both LA and RA are offer advantages to patients and are comparable in outcomes. RA offers the potential for increased visualization and faster learning curve which may allow for both faster, and more precise dissection, as well as increased utilization of minimally invasive techniques. While LA remains the standard of care, RA is an excellent option in high volume robotic centers from standpoints of outcomes, feasibility, and cost.

Radiographic morphology of the ulnar head.

Posteroanterior radiographs of 102 normal wrists were studied to determine the morphological characteristics of the ulnar head associated with the value of ulnar variance. Ulnar variance, ulnar styloid length, ulnar head diameter, ulnar seat inclination, and the distance of ulnar head peak to the distal radioulnar joint were measured together with the third metacarpal length as a reference of the size of the wrist. Moderate correlation was confirmed not only between ulnar variance and ulnar seat inclination but also between ulnar variance and the distance of the ulnar head peak. Furthermore, we found a statistically significant correlation between ulnar variance and ulnar head diameter. The results showed that whole ulnar head configurations are affected by ulnar variance although there are considerable variations.