title: Laparoscopic radical adrenalectomy with adrenal vein tumor thrombectomy: technical considerations.
abstract: OBJECTIVE
  We describe the technique of adrenal vein tumor thrombectomy during laparoscopic radical adrenalectomy for cancer.
  
  
  METHODS
  During laparoscopic adrenalectomy for a heterogeneous 7 cm left adrenal mass an adrenal vein thrombus was detected intraoperatively. Laparoscopic ultrasonography was used to delineate precisely the tumor thrombus and its extension into the left main renal vein. The left renal artery and vein were transiently controlled with atraumatic vascular clamps. The renal vein was incised and the intact tumor thrombus was removed en bloc with the radical adrenalectomy specimen. The renal vein was suture repaired with 4-zero prolene and the kidney was revascularized.
  
  
  RESULTS
  Renal warm ischemia time was 21 minutes, blood loss was 300 cc and operative time was 6.2 hours. Pathological evaluation revealed a 7.5 cm 68 gm adrenal cortical cancer with tumor thrombus. Soft tissue and adrenal vein margins were negative for cancer.
  
  
  CONCLUSIONS
  Laparoscopic radical adrenalectomy with en bloc adrenal vein tumor thrombectomy can be exclusively performed intracorporeally, while respecting oncological principles. Essential technical steps include wide margin excision of the adrenal gland, intraoperative ultrasonography, renal vascular control, en bloc tumor thrombectomy and renal venous suture repair in a bloodless field.
authors.affiliation: Section of Laparoscopic and Minimally Invasive Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Ja-Hong
authors.initials: JH
authors.lastname: Kim
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ng
authors.forename: Anup P
authors.initials: AP
authors.lastname: Ramani
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Spaliviero
authors.forename: Brian
authors.initials: B
authors.lastname: Herts
authors.forename: Jihad
authors.initials: J
authors.lastname: Kaouk
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
mesh_terms: D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy; D009360:Neoplastic Cells, Circulating