As is the case with many minimally invasive surgical techniques, laparoscopic adrenalectomy has become the gold standard for the surgical treatment of most adrenal tumors. Several techniques are in use today. In this article we describe 1 such technique, highlight the common pitfalls encountered by the surgeon, and discuss how to avoid them.
Studies have shown a steady and significant decrease in the frequency and number of complications with the laparoscopic procedure when compared with the open technique.1However, critical steps of the minimal-access operation may be accompanied by severe pitfalls for the unwary surgeon. This article highlights these complications and suggests ways to prevent them.
Left adrenalectomy. Dissection begins with medial retraction of the left colon.
Splenic flexure mobilization with Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, Ohio) followed by division of the lateral attachments of the descending colon and the splenic flexure.
Left adrenal gland visualization. The spleen has been mobilized and retracted medially, exposing the left adrenal gland and adenoma in the retroperitoneum. In small glands, intracorporeal ultrasound helps to detect the gland.
Left adrenal vein visualization. The left adrenal vein is seen draining into the left renal vein.
Visualization of the right adrenal gland and division of the lateral attachments of the liver. The liver is retracted medially, and the peritoneum is divided to locate the right adrenal gland in the retroperitoneum.
Visualization of the inferior vena cava and right adrenal vein. Once the retroperitoneum is entered, careful dissection along the right wall of the inferior vena cava will reveal the short right adrenal vein draining into it.
Right adrenal vein after it has been clipped, separated from the inferior vena cava, and divided. Meticulous and careful technique will avoid inferior vena cava injury.
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