Laparoscopic appreciation of the adrenal artery: fact or fiction?
BACKGROUND
It is well accepted that identification and control of the adrenal vein is a critical step in laparoscopic adrenalectomy. The surgical and anatomic literature propagates the notion of a dominant or multiple dominant adrenal arteries that should likewise be controlled during surgical extirpation.


METHODS
We assessed the frequency of adrenal-artery identification and the need for formal ligation in an extensive series of laparoscopic adrenalectomies.


RESULTS
In our experience, even using a magnified laparoscopic view, we found it possible to identify and necessary to formally ligate an adrenal artery in only 3 of 265 cases (1.1%). Further, in this series, only the inferior adrenal artery was ever seen definitively to require formal clip ligation, while a discrete middle or superior adrenal artery was almost never seen, and the vasculature in these areas could be controlled with electrocautery or ultrasonic energy alone during routine dissection.


CONCLUSIONS
The need to search for and ligate the arterial supply during laparoscopic adrenalectomy is not as clinically significant as once thought, and formal control appears unnecessary unless the vessels are serendipitously encountered during the routine dissection.
Joel
Andrew B
AB
Department of Urology, University of California-San Francisco, CA 94143, USA.
Rubenstein
Jonathan N
JN
Arredondo
Shelley
S
Meng
Maxwell V
MV
Duh
Quan-Yang
QY
Stoller
Marshall L
ML
D000311:Adrenal Glands / Q000098:blood supply*; D000315:Adrenalectomy / Q000379:methods*; D001158:Arteries / Q000033:anatomy & histology / Q000601:surgery*; D016063:Blood Loss, Surgical; D004210:Dissection; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008026:Ligation; D014680:Veins / Q000033:anatomy & histology / Q000601:surgery; D014741:Video Recording