Surgical Technique

Laparoscopic approaches to the adrenal gland can be transperitoneal, retroperitoneal lateral, or retroperitoneal posterior. Although each of these approaches have their own advantages and disadvantages, the choice of approach depends on surgeon's experience and preference. The transperitoneal approach is the most popular, because of easier orientation. However, delayed bowel function and adhesion formation can possibly occur. The retroperitoneal approach is gaining popularity because it allows direct access to the adrenal gland without interfering with intra-abdominal organs. However, with this approach, the working space is limited and anatomical landmarks may be difficult to recognize especially for the beginner laparoscopist. The only randomized, prospective study on this topic documented equivalent patient outcomes between transperi-toneal and retroperitoneal adrenalectomy (35). The authors prefer the transperitoneal approach because it allows direct approach to the adrenal vein especially on the right side where the adrenal gland is just posterior to the peritoneal sac. This is particularly important in pheochromocytoma. Walz et al. and Baba et al. popularized the retroperi-toneal posterior approach for adrenalectomy (36,37). Sasagawa et al. have successfully performed laparoscopic partial adrenalectomy through this approach (26).

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