Left adrenalectomy, laparoscopic

Anatomy Perioperative management Technique Complications Evidence Total Video

Content

CT findings
Trocar positioning
Freeing the descending colon
Opening the prerenal space
Dissecting the spleen off the diaphragm
Exposing the superior left retroperitoneum
Accessing the adrenal
Mobilizing the adrenal tumor
Transecting the central suprarenal vein
Transecting the arterial blood supply
Removing the entire adrenal
Retrieving the specimen and placing a drain
Wound closure

Authors

Dr. med. Katharina von Schenk

Lukaskrankenhaus Neuss

Prof. Dr. med. Peter Goretzki

Charite Berlin

CT findings

Imaging demonstrates a multinodular 5cm–6cm large cyst-like mass in the region of the left adrenal, clinically confirmed as pheochromocytoma.
Trocar positioning

Perform medial 2cm long minilaparotomy in left upper quadrant for the trocar of the laparoscope and then initiate pneumoperitoneum. After exploration of the abdominal cavity introduce two more working trocars – one 5mm trocar in the left upper quadrant and a Versa-Port V12 anterior to the 11^thrib.
Freeing the descending colon

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Pull the descending colon mediad and incise the retroperitoneum in the avascular plane anterior to the left kidney.
Opening the prerenal space

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Approach the left adrenal laterally by freeing the left colic flexure step by step from the retroperitoneum until large parts of the anterior aspect of the Gerota fascia and renal capsule have been exposed.
Note:In slender patents it may become difficult to spare the Gerota fascia.
Dissecting the spleen off the diaphragm

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Now transect the suspensory ligaments tying the spleen to the diaphragm, which then allows en blocmobilization of the spleen and pancreatic tail.