Laparoscopic direct supragastric left adrenalectomy

BACKGROUND: In this paper a novel laparoscopic approach to the left adrenal gland by the transabdominal anterior route is presented. This approach avo ids an extensive viscera dissection to gain access to the left adrenal glan d. METHODS: The first step of the procedure is the division of the gastrophren ic ligament and the section of 1 or 2 short gastric vessels in order to mob ilize the gastric fundus. The gastric fundus is then pulled down, allowing a wide exposure of the left crus of the diaphragm, the perirenal fat, and t he superior edge of the pancreatic body. The diaphragmatic-adrenaI channel runs on the left crus, crosses the middle adrenal artery, and, usually, joi ns the left adrenal vein before its junction with the left renal vein. By p ulling on the diaphragmatic vein, exposure of the adrenal vein is facilitat ed. The adrenal vein is then isolated and divided between clips. Using the monopolar electrocautery to control arteries and small veins, the mobilizat ion of the gland is then completed. The adrenal gland is then placed in a p lastic bag to prevent cell spillage and removed through an enlarged umbilic al incision. RESULTS: During a 20-month period, 6 consecutive patients with left adrenal gland neoplasms have been operated on with the above mentioned original ap proach. The diameter of the adrenal mass ranged from 3 cm to 6 cm. No conve rsion to open surgery or complications have been registered. The mean opera tive time was 126 minutes. The mean length of hospitalization was 4.1 days (range 3 to 6). CONCLUSIONS: This approach offers a complete visualization of the left adre nal gland, avoiding mobilization of the spleen, pancreatic tail, and left f lexure of the colon, and allows an early and easy control of the left adren al vein so adrenalectomy can be safely performed. (C) 1999 by Excerpta Medi ca, Inc.