Summary

■ Laparoscopic adrenalectomy has become the standard surgical approach for most surgically correctable disorders of the adrenal gland.

■ Aldosteronomas may be considered as lesions of choice for surgeons early in the operative learning curve.

■ Unilateral laparoscopic adrenalectomy is the treatment of choice for patients with Cushing's syndrome due to unilateral adrenal adenomas.

■ After initial controversy, laparoscopic adrenalectomy for pheochromocytoma is now well accepted as a standard indication for unilateral or bilateral disease.

■ The quintessential objective during laparoscopic adrenalectomy is early control of the adrenal vein and in this regard, pheochromocytomas are best suited to the transperitoneal approach.

■ Masses demonstrating local organ invasion or venous tumor thrombus are not suitable for laparoscopic resection because the ability to achieve an adequate en-bloc resection is extremely difficult in this setting.

■ Early access to the adrenal vein prior to manipulation of the adrenal gland or periadrenal tissue is the main advantage of the lateral transperitoneal route.

■ The posterior retroperitoneal approach utilizes the prone jack-knife position. In addition to the advantages and disadvantages of the retroperitoneal approach, it also allows access to both glands for bilateral procedures.

■ Tumor size, obesity, and the learning curve are the most important factors influencing operative outcome.

■ The aim of a right-sided laparoscopic adrenalectomy is to remove the adrenal gland with early ligation of the adrenal vein. It is essentially a dissection of the inferior vena cava.

■ The aim of a left-sided laparoscopic adrenalectomy is to remove the adrenal gland and periadrenal fat with early ligation of the adrenal vein. It is essentially a dissection of the left renal vein.

■ At all times, patient safety is paramount, and it is essential that the practitioner has a low threshold for open conversion to control significant hemorrhage.

An experienced human assistant familiar with the modus operandi of the primary surgeon will provide a dynamic view of the object of interest in a much more expedient fashion than a voice-activated robot, particularly during complex maneuvers such as intracorpo-real suturing.

0 0

Post a comment