Laparoscopic Adrenalectomy: Step-By-Step Surgical Skills

Abstract

Introduction and Objective:

To introduce step-by-step skills and to show the learning curve of pure laparoscopic adrenalectomy performed by a single surgeon.

Materials and Methods:

From October 2008 to September 2011, 74 patients out of 112 who were diagnosed as adrenal mass received pure laparoscopic adrenalectomy. Eight cases were bilateral, and 66 cases were unilateral. After placing the patient in the flank position, a 12-mm camera port is inserted near umbilicus. Two 5-mm working ports are placed at the cross-sections of the midclavicle line, anterior axillary line, and subcostal margin. About 2-mm port for liver retraction is placed just below the xiphoid process if the mass is on the right side. When performing a right adrenalectomy, an avascular triangle formed by the vena cava, liver, and renal vein is identified. The adrenal gland is lifted up using a pair of forceps or suction, and adrenal vein is ligated. Inferior phrenic vascular supply at the liver margin and renal hilum vascular supply at the upper pole margin of kidney are secured in order, and then, the adrenal gland is removed. When performing a left adrenalectomy, the line of Toldt, splenocolic ligament, and splenic flexure are incised. The plain between the descending colon, pancreas, spleen, and perirenal fascia is split and flipped over all the way to the medial side. After identifying the renal vein, the adrenal vein is ligated. Following procedures are the same as on the right side. The camera scope is replaced to 5 mm and inserted into 5-mm working port, and a 12-mm port is used for delivering specimen. Drain is not inserted.

Results and Conclusions:

There was significant improvement in the average operation time (90 vs. 53 minutes, p=0.003) of the latter 33 unilateral laparoscopic adrenalectomies compared to the prior 33 cases. The estimated blood loss (130 vs., 50 mL, p<0.001) also deceased, but had no clinical significance, since it did not exceed 350 mL in both groups. With the knowledge of anatomical structures near the adrenal glands, the surgical techniques introduced here in this video clip will help the surgeon with little experience with adrenalectomy to overcome the learning curve.

No competing financial interests exist.

Runtime of video: 5 mins 12 secs