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.