title: Transperitoneal laparoscopic adrenalectomy for metachronous contralateral adrenal metastasis from renal cell carcinoma: a case report.
abstract: BACKGROUND
  We report a case of metachronous solitary metastasis of renal cell carcinoma to the contralateral adrenal gland treated by laparoscopic transperitoneal adrenalectomy.
  
  
  METHODS
  A 58-year-old man presented to our institution for regular follow up, 2 years after a right radical nephrectomy with preservation of the ipsilateral adrenal gland, for a primary renal cell carcinoma. The patient remained asymptomatic but an abdominal computed tomography scan on follow up revealed a 6.5 x 4 cm2 mass in the left adrenal gland. A positron emission tomography scan was also performed to rule out other possible metastases, and a magnetic resonance imaging scan was used for accurate localization and determination of resectability of the adrenal tumour. A bone scan, metabolic screen, liver and renal function tests were all within normal limits. A laparoscopic transperitoneal adrenalectomy was then performed. The postoperative period was uneventful, and the patient was discharged on postoperative day two. The patient remains in satisfactory condition and no recurrence or adrenal insufficiency has been observed during 12 months follow up.
  
  
  CONCLUSIONS
  Metachronous contra lateral adrenal metastases from primary renal cell carcinoma are very rare but should always be suspected in any nephrectomised patient presenting with an adrenal tumour. Regular follow up in these patients accompanied with computed tomography imaging may help the surgeon to detect early lesions. Laparoscopic transperitoneal adrenalectomy is feasible, safe and effective, with minimal trauma to the patient.
authors.affiliation: Section of Laparoscopic Urology, The Institute of Urology, University College Hospital, London, UK. evangelos.zacharakis@doctors.org.uk.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Zacharakis
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Ribal
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Zacharakis
authors.forename: Hiten Rh
authors.initials: HR
authors.lastname: Patel