Endocrine: Adrenalectomy

Adrenalectomy

Anatomy

Positioning

  • Lateral Decubitus – Ipsilateral Side Up
  • Bed Flexed 15-Degrees at the Lower Chest

Laparoscopic Transabdominal Adrenalectomy

  • Achieve Pneumoperitoneum at Selected Site (Often at Palmer’s Point)
  • Place Ports
    • Generally Use Three 5-mm Trocars and One 12-mm Trocar
    • May Require More for Additional Retraction/Exposure
  • Dissection
    • Take Care Not to Rupture Capsule – Risk for Tumor Spillage
    • Left-Sided
      • Mobilize the Splenic Flexure of the Colon – Divide Attachments to Kidney and Gerota’s Fascia
      • Mobilize the Spleen
      • Dissect the Avascular Plane Between the Posterior Surface of the Pancreas & the Anterior Surface of Gerota’s Fascia
        • This Will Expose the Adrenal Vein Draining into the Middle Left Renal Vein
        • Watch for the Left Phrenic Vein Which May Be Seen Joining the Adrenal Vein Medially
    • Right-Sided
      • Incise the Triangular Ligament of the Liver (Peritoneal Reflection)
      • Retract the Liver
      • May Also Require a Kocher Maneuver to Better Retract the Duodenum – Usually Not
      • Begin Dissection Medially to Identify the Adrenal Vein Draining into the IVC
  • Divide the Adrenal Vein Using Clips
  • Dissect the Adrenal Gland, Medial-to-Lateral
    • Divide/Ligate Smaller Vessels with Electrocautery/Harmonic
  • Remove Adrenal Gland in a Retrieval Bag
  • Ensure Hemostasis
  • Close Fascia of the 12-mm Trocar Site
  • Desufflate and Close Incisions

Alternative Approaches

  • Posterior Retroperitoneoscopic Adrenalectomy
  • Open Adrenalectomy

Adrenal Vasculature 1

Left Adrenalectomy Port Placement

Right Adrenalectomy Port Placement

Left Adrenal Vein Draining into the Renal Vein 2

Right Adrenal Vein Draining into the IVC 2

References

  1. Uludağ M, Aygün N, İşgör A. Surgical Indications and Techniques for Adrenalectomy. Sisli Etfal Hastan Tip Bul. 2020 Mar 24;54(1):8-22. (License: CC BY-NC-4.0)
  2. Mellon MJ, Sethi A, Sundaram CP. Laparoscopic adrenalectomy: Surgical techniques. Indian J Urol. 2008 Oct;24(4):583-9. (License: CC Not Specified)