Adrenalectomy (Laparoscopic, Open)

Procedure Snapshot

• Indication: Functional or non-functional adrenal tumors; incidentaloma > ___ cm (PMID 36180469).
• Expected duration: ___
• Special instruments: Energy device, vascular clips, 30° scope, retrieval bag.

Step Workflow

1. Lateral decubitus; flex table to open flank.
2. Mobilize colon and spleen/pancreas (left) or liver (right).
3. Identify adrenal vein (left → renal vein; right → IVC).
4. Clip/divide adrenal vein early.
5. Mobilize gland circumferentially.
6. Extract in bag; inspect bed.

Key Pimp Questions

• Q: Which adrenal easier laparoscopically?
  A: Left — longer vein to renal vein.
• Q: When is open preferred?
  A: Size > 6 cm, invasion, malignancy (PMID 33901052).
• Q: Pre-op for pheochromocytoma?
  A: α-blockade ≥ 10 days, then β-blockade (PMID 33098986).

Critical Anatomy

• Landmarks: Adrenal vein, IVC/renal vein, diaphragm crus.
• Danger zones: IVC (right), pancreas tail/splenic vessels (left).

Informed Consent Highlights

• Benefits: Cure/control of hormone excess.
• Alternatives: Observation or ablation.
• Risks:
  • Bleeding ___ (PMID 35846073)
  • IVC/renal vein injury ___
  • Adrenal insufficiency ___
  • Conversion to open ___

Post-op Considerations

• Monitor hemodynamics (pheochromocytoma).
• Check cortisol; steroid coverage if bilateral.
• Early ambulation.

References

• Chassin’s, Endocrine section.
• Clinical Scenarios, Adrenal chapter.
• Scholten 2013 (PMID 23168373).