Ricerc@Sapienza

Minimally invasive adrenalectomy is the treatment of choice for benign adrenal lesions (like Conn’s and Cushing’s syndrome) including pheocromocytoma (PHE) and in selected patients with malignant lesions, also in bilateral lesions. 

The authors compare the results of three different laparoscopic transperitoneal surgical approaches: lateral transperitoneal (LT), anterior transperitoneal (AT) and anterior transperitoneal submesocolic (ATS), for the treatment of left adrenal disease.

In case of Conn’s or Cushing’s syndrome, left laparoscopic adrenalectomies with ATS approach is equally safe and effective as compared to the LT and AT approaches. Early control of the adrenal vein with minimal gland manipulation and limited surgical dissection are the major advantages of the submesocolic approach, and postoperative results are the same as those reported in the literature with other approaches.

Furthermore, the early ligation of the main adrenal vein prior to any gland manipulation reduces the risk of catecholamines' spread and consequently the risk of hemodynamic instability in treatment of PHE. Intraperitoneal dissection is limited and there is no need to mobilize the colon or pancreas, with a lower risk of complications from organ manipulation.

In our experience, transperitoneal anterior adrenalectomy was feasible and safe also in bilateral lesions. Based on our results, we believe that this approach leads to prompt recognition of anatomical landmarks with early division of the main adrenal vein prior to any gland manipulation, with a low risk of bleeding and without the need to change patient position. Unlike the lateral approach, there is no need to mobilize the spleno-pancreatic complex on the left or the liver on the right.