Safety of adrenal vein ligation during endoscopic adrenalectomy - A technical note

Endoscopic adrenalectomy has been recommended for the treatment of several benign adrenal diseases. The safety of this procedure largely depends on a careful surgical dissection and appropriate hemostatic technique. An establ ished slipknotting technique was employed to control the main adrenal vein in a consecutive series of 14 patients undergoing endoscopic adrenalectomy. The operative steps to ligate the adrenal pedicle are described. A Medline search also was conducted to identify all reported bleeding episodes assoc iated with this procedure. All attempted ligatures of the main adrenal vein were completed successfully by the described technique, and none of our pa tients required perioperative blood transfusion. Twenty-eight episodes of b leeding collected from the literature were analyzed. Hemorrhagic accidents related to dislodgement of clips were documented at least in three patients , The cause of bleeding was unspecified in 10 patients, Extracorporeal liga tion of the main adrenal vein is feasible, safe, and advisable to prevent t he occurrence of hemorrhage during endoscopic adrenalectomy.