Since its inception in 1992, laparoscopic adrenalectomy has evolved as the procedure of choice for the vast majority of surgical pathologies of the adrenal gland and has clear benefits when compared to open surgery. Procedural advancements have resulted in the development of new approaches to the adrenal, from the initial anterior trans-peritoneal approach, to the lateral transperitoneal approach, posterior and lateral retroperitoneal approaches, and more recently the thoracoscopic approach. Comparative studies to date have not demonstrated significant differences in outcome measures between transperitoneal and retroperitoneal routes. We prefer the lateral transperitoneal approach because of its particular advantage in allowing early control of the adrenal vein.

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