Anterior Transperitoneal Technique

As discussed previously, this approach has been largely superseded by the lateral transperitoneal approach. Typically, the patient is placed in either the supine or the semilateral position (9,58,88). Ports are generally placed in a subcostal arrangement (9,58,88). On the right side, the liver is retracted superiorly, and the paracaval posterior peritoneum is incised to achieve direct access to the inferior vena cava and therefore the adrenal vein (9,58,88). Once the vein has been divided, the adrenal is then mobilized (9,58,88). On the left side, the splenic flexure is mobilized medially and access to the adrenal achieved by reflecting the stomach and pancreatic tail medially (9,88). The adrenal vein is identified and divided, and the adrenal gland is then mobilized and removed (9,58,88).

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