Narrated R Adrenal Coolseal

Patient was a 3½-year-old female who presented with chronic cough and chest pain, with CT scan showing right perirenal mass

The Cool Trinity 5 mm device has very low energy profile and heat spread, allowing dissection without worry of injury to the colon

The fine tips of the 5 mm jaw allow for both grasping and fine dissection between tissue planes

The tumor was directly on the inferior vena cava and densely adherent, as represented in the CT scan

The visualization afforded by the dual action and fine tips is better than all other tissue sealing devices and is equivalent to that of a 5 mm Maryland

At no time during this procedure was it necessary to remove the Trinity and insert a different grasping or dissecting device because of its ability to perform both functions

The device allows sealing and dividing tissues with separate actions, which is critically important for ensuring adequate hemostasis before division

The tissue between tumor and IVC was quite thick and inflamed, making the plane difficult to identify

The minimal heat spread ensures no damage to adjacent structures such as kidney, liver, bowel, or vena cava

There is minimal sticking following the sealing of tissues with the device

The device is taken out periodically to clean the jaws to remove any small amount of char

This procedure took under 2 hours

The tumor was placed in an endoscopic bag and brought out through an elongated umbilical incision, saving the child significant morbidity from a large open procedure

The child was discharged on the 2nd postoperative day

The pathology came back consistent with a neuroblastoma arising from the right adrenal gland