Sub-mesocolic access in laparoscopic left adrenalectomy.
BACKGROUND
This article reports an alternative laparoscopic access to left adrenal gland.


METHODS
From January 1994 to August 2004, 209 laparoscopic adrenalectomies were performed in our Department. Indications were Conn adenoma (55 cases), incidentaloma (64), Cushing adenoma (45), pheochromocytoma (32), adreno-genital syndrome (two), mielolipoma (two), and metastatic mass(nine). Of 209, in 12 cases the left adrenalectomy was performed through a submesocolic access (seven pheochromocytoma, two incidentaloma, two Cushing adenoma, one Conn adenoma,). The identification and closure of the adrenal vein with minimal gland manipulation resulted the main benefit of this approach. Moreover, the adrenalectomy was performed with minimal anatomical dissection.


RESULTS
No mortality or major complications occurred. During the operation, the blood pressure and cardiac rhythm were significantly more stable, in the group of patients who underwent a left adrenalectomy by the submesocolic approach compared to the anterior or flank lateral transperitoneal group.


CONCLUSIONS
Left adrenal lesions, as selected cases of pheochromocytoma, can be safely treated by laparoscopic submesocolic access.
Perretta
S
S
Clinica di Chirurgia Generale e Metodologia Chirurgica-Ospedali Riuniti, 60121, Ancona, Italy.
Campagnacci
R
R
Guerrieri
M
M
Paganini
A M
AM
De Sanctis
A
A
Sarnari
J
J
Rimini
M
M
Lezoche
E
E
D000306:Adrenal Cortex Neoplasms / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D018246:Adrenocortical Adenoma / Q000601:surgery; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000601:surgery; D013525:Surgical Instruments