Surgical Anatomy

The adrenal glands are paired structures adjacent to the upper poles of the kidneys in the retroperitoneum. Each gland weighs 3 to 8 g. The right adrenal is triangular and slightly smaller and more superiorly located than the left gland. The left adrenal gland is elongated and flatter than the right gland. Both glands are contained within Gerota's fascia and are directly surrounded by fat and connective tissue.

The glands themselves may be differentiated from the surrounding adipose tissue by their golden, yellow-brown color. The right adrenal gland is bordered by the IVC medially, the bare area of the liver anteriorly, and the diaphragm both superiorly and laterally. Division of the right triangular ligament of the liver, which provides lateral fixation of the liver, can facilitate exposure of the right adrenal by allowing retraction of the right hepatic lobe both anteriorly and medially.10 The left adrenal gland is bordered by the aorta medially, the cardia of the stomach and the pancreatic tail anteriorly, the left renal vein inferiorly, and the diaphragm superiorly and laterally. The arterial supply to the adrenals may be variable, although in most patients it comes from the inferior phrenic artery superiorly, the aorta laterally, and the renal artery inferiorly. The venous supply is more constant but may pose a greater technical problem if not understood. The right adrenal gland is drained by a short adrenal vein that enters the IVC posterolateral^. Because of its location, and because it can be difficult to visualize, it is at risk for injury. The resultant hemorrhage is often difficult to control. The left adrenal gland drains into the left renal vein and is usually fairly prominent.

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