General Technical Modifications Procedural Modifications

The technique of lateral transperitoneal laparoscopic adrenalectomy is quite consistent in most accounts. Port positions differ slightly according to the surgeon's preference. Generally, four ports are required, with one camera port, two working ports, and one additional port for retractor placement. Most reports describe a subcostal arrangement along the line of the costal margin (24,35,37,45,50,80); however, they may also be placed in a quadrangular arrangement beneath the costal margin (81).

The primary camera port may be placed in the midline at a supraumbilical site (45) and may also be moved among the ports to aid vision (50,81). Some authors describe mobilizing or defining the adrenal prior to securing the adrenal vein (7,50,82). For the reasons stated, we do not believe that this is consistent with achieving an optimal surgical outcome.

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