title: Is preservation of the adrenal vein mandatory in laparoscopic adrenal-sparing surgery?
abstract: OBJECTIVE
  Adrenal tissue-sparing or partial adrenalectomy evolved initially for patients with bilateral synchronous adrenal surgical pathology to preserve vital adrenal volume. In the laparoscopic era, the exact criteria for performing such procedures laparoscopically have yet to be defined. Controversy exists regarding the importance of preserving the adrenal vein, main or accessory. The aim of this retrospective study was to present our short series of laparoscopic tissue-sparing adrenalectomies with vein preservation. Our main goal is not to support partial adrenalectomy as an alternative to total (this is already advocated by many surgeons) but to emphasize the vein-preserving technique.
  
  
  METHODS
  Seven patients with peripherally located either aldosterone-producing adenomas (4 cases) or myelolipomas (4 cases) underwent laparoscopic lateral partial adrenalectomy. One patient harbored an aldosterone-producing adenoma and a myelolipoma as well. The main adrenal vein was identified and preserved in 6 patients and the accessory vein in one.
  
  
  RESULTS
  No conversion to open adrenalectomy was necessary, and no perioperative morbidity or mortality occurred. Three adenoma patients are normotensive 44, 23, and 20 months postoperatively, while the fourth one's pressure is refractory.
  
  
  CONCLUSIONS
  Surprisingly, total adrenalectomies preceded the partial ones, which is controversial compared with other procedures. Laparoscopic lateral partial adrenalectomy is a technically challenging tissue-sparing operation. Meticulous dissection allows preservation of the middle artery and main or accessory vein resulting in a functioning adrenal stump.
authors.affiliation: Department of Surgery, POLYCLINIC Hospital, Athens, Greece. nicrouk@ath.forthnet.gr
authors.forename: N
authors.initials: N
authors.lastname: Roukounakis
authors.forename: S
authors.initials: S
authors.lastname: Dimas
authors.forename: I
authors.initials: I
authors.lastname: Kafetzis
authors.forename: S
authors.initials: S
authors.lastname: Bethanis
authors.forename: N
authors.initials: N
authors.lastname: Gatsulis
authors.forename: H
authors.initials: H
authors.lastname: Kostas
authors.forename: V
authors.initials: V
authors.lastname: Kyriakou
authors.forename: S
authors.initials: S
authors.lastname: Michas
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000311:Adrenal Glands / Q000098:blood supply* / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006929:Hyperaldosteronism / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D018209:Myelolipoma / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014680:Veins / Q000601:surgery*