Laparoscopic adrenalectomy

Abstract

In the last three decades, endoscopic adrenalectomy has become the gold standard for the surgical treatment of most adrenal diseases. Gagner et al., first reported in 1992, the lateral trans-abdominal laparoscopic approach to adrenalectomy. Afterwards, several retrospective and comparative studies addressed the advantages of minimally invasive adrenalectomy specifically consistent in less postoperative pain, improved patients' satisfaction, shorter hospital stay and recovery time when compared to open adrenalectomy. The lateral transabdominal approach to the adrenals is currently one of the most widely used, since it allows an optimal comprehensive view of the adrenal region and surrounding structures, and provides and adequate working space. On the other hand, from a technical point of view, essential requirements for a successful laparoscopic adrenalectomy are an appropriate knowledge of retroperitoneal anatomy, a gentle tissue manipulation and a precise haemostasis technique in order to identify appropriately the structures of interest and avoid the troublesome 'oozing' that could complicate the surgical procedure.

Keywords: Laparoscopic adrenalectomy; adrenal tumours; endoscopic adrenalectomy; personalized medicine.

Figure 1

Trocars position for right laparoscopic transabdominal lateral adrenalectomy (TLA).

Figure 2

Trocars position for left laparoscopic transabdominal lateral adrenalectomy (TLA).

Figure 3

Real time laparoscopic lateral transabdominal right adrenalectomy (22). Available online: http://www.asvide.com/article/view/32876

Figure 4

Dissection of the right triangular and hepatopatietal ligaments allow obtaining an effective mobilization of the liver.

Figure 5

Exposition of the adrenal gland and of the inferior vena cava.

Figure 6

Dissection of the plane between the adrenal gland and the inferior vena cava and identification of the right main adrenal vein.

Figure 7

Dissection of the right main adrenal vein.

Figure 8

Real time laparoscopic lateral transabdominal left adrenalectomy (23). Available online: http://www.asvide.com/article/view/32880

Figure 9

Dissection of the left colonic flexure.

Figure 10

Dissection of the splenoparietal ligament: the dissection is performed far enough to visualize the greater curvature of the stomach.

Figure 11

The splenopancreatic bloc is displaced medially.

Figure 12

Identification and dissection of the left main adrenal vein.