Laparoscopic left adrenalectomy for incidentally detected large adrenal mass
Epublication WebSurg.com, Nov 2013;13(11). URL: http://websurg.com/doi/vd01en4063
We report the typical case of a young woman presenting with an incidentally detected large left adrenal mass. This was a non-functional tumor incidentally detected during ultrasound scan for other reason. CT-scan confirmed a large adrenal mass with diffuse contrast-enhancement. Blood tests for adrenal function were negative. A laparoscopic left adrenalectomy was proposed with the main objective to perform a complete left adrenalectomy since the malignant nature of the mass cannot be excluded by available imaging studies. For laparoscopic left adrenalectomy, the patient is in a typical right lateral position. The optical trocar is in the left subcostal position. A 10mm trocar is introduced into the anterior axillary line while other 5 or 10mm trocars are placed laterally under the costal margin. For the surgical resection of this large tumor, dissection started with the opening of the retroperitoneal space, and with the mobilization of the spleen and tail of pancreas. The renal vein is the secondary key point of dissection, allowing to identify the main adrenal vein. At this point, dissection is continued on the right side of the gland in order to identify the left adrenal artery, up to the inferior phrenic vein, and to the superior adrenal artery. The mass is cleared and removed through the extraction bag. Editorial note: Luigi Mearini et al. have reported a left adrenalectomy exactly reproducing anatomical and technical principles as detailed on WebSurg.com. This confirms that the technique can be reproduced easily.