Laparoscopic Adrenalectomy

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Author: David Schwartzberg
Published:
Specialties: General Surgery, Robotic Surgery
Schools: NYU Langone Medical Center, New York University Langone Medical Center
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Basic Info

Laparoscopic adrenalectomy (LA) was first described by Gagner et al. in the early 1990s, and has since become the gold standard for removal of small and medium sized adrenal tumors.

Most commonly, LA is performed for unilateral benign adrenal lesions, however the minimally invasive technique is also routinely used for bilateral disease, as well as myelolipomas, adrenal cysts, adrenal hemorrhage and androgen-secreting tumors.  Compared with the open approach, LA offers shorter hospital stay, improved patient satisfaction, decrease post-operative pain and markedly improved cosmesis.  Even more, the difficulty in obtaining adequate open surgical exposure, combined with the diminutive size of the adrenal gland make laparoscopy an especially attractive option. Given this, we decided to proceed with LA approach for our patient who presented with NSCLC metastasis to his right adrenal.

DOI# http://dx.doi.org/10.17797/4ek02iupxd

Mellon MJ, Sethi A, Sundaram CP. Laparoscopic adrenalectomy: Surgical techniques. Indian Journal of Urology : IJU : Journal of the Urological Society of India. 2008;24(4):583-589. doi:10.4103/0970-1591.44277.

Gagner M, Lacroix A, Bolte E. Laparoscopic adrenalectomy in Cushing's syndrome and pheochromocytoma. N Engl J Med. 1992;327:1033.

Advanced

Procedure

laparoscopic adrenalectomy

Indications

small and medium sized adrenal tumors

Contraindications

any contraindication to laparoscopy

Instrumentation

Setup

left lateral decubitus with appropriate pressure padding

Preoperative Workup

cross sectional imaging and routine preoperative lab work

Anatomy and Landmarks

psoas muscle, diaphragm, inferior vena cava (IVC), adrenal vein and artery, kidney with Gerota's fascia

Advantages/Disadvantages

laparoscopic advantages include less post operative pain and shorter length of stay

Complications/Risks

general concerns of bleeding, infection and damage to nearby organs, with operative-specific injuries to the IVC, liver and diaphragm

Disclosure of Conflicts

general concerns of bleeding, infection and damage to nearby organs, with operative-specific injuries to the IVC, liver and diaphragm

Acknowledgements

NYU Langone Dept of Surgery

References

Mellon MJ, Sethi A, Sundaram CP. Laparoscopic adrenalectomy: Surgical techniques. Indian Journal of Urology�¢ï¿½�¯: IJU�¢ï¿½�¯: Journal of the Urological Society of India. 2008;24(4):583-589. doi:10.4103/0970-1591.44277.

Gagner M, Lacroix A, Bolte E. Laparoscopic adrenalectomy in Cushing's syndrome and pheochromocytoma. N Engl J Med. 1992;327:1033.

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