Technique of transperitoneal laparoscopic adrenalectomy.

Adrenalectomy can be successfully and safely carried out with a laparoscopic technique, using standard instrumentation via a transperitoneal approach. We describe five tasks to be completed by the surgeon: (a) generation of pneumoperitoneum and port placement, (b) exposure of the adrenal gland, (c) dissection of the adrenal gland, (d) clipping of the adrenal vein, and (e) removal of the adrenal gland and fascial closure of port sites. Each step is described in detail for right and left adrenalectomy. Laparoscopic adrenalectomy is advocated on the same grounds as other laparoscopic procedure, namely, decreased postoperative pain and ileus, a better cosmetic result, decreased hospital stay, and a shorter convalescent period. Some other advantages of the laparoscopic technique are: minimal extent of dissection and excellent visibility and exposure of the adrenal gland.