What are the possible laparoscopic approaches for adrenalectomy?
- The most common technique is via an anterolateral laparoscopic transabdominal approach in which the patient is placed in the lateral decubitus position with the side of the lesion up.
- This provides excellent exposure but does not permit removal of both glands without repositioning the patient.
- A supine anterior transabdominal approach provides access to both adrenal glands, but exposure is more difficult.
- A posterior laparoscopic retroperitoneal approach (retroperitoneoscopic) in the prone position avoids entering the peritoneal cavity altogether and affords access to both adrenals without repositioning but is limited by a smaller working space that precludes removal of larger lesions (> 4 cm).
- The various laparoscopic approaches are felt to be equivalent in terms of safety and recovery, and are selected according to the surgeon’s preference and patient/tumor characteristics.
