Endocrine

Adrenalectomy (Laparoscopic)

ADRENALECTOMY (LAPAROSCOPIC)

Indication: Adrenal adenoma (Conn's syndrome/primary aldosteronism — unilateral), phaeochromocytoma (after adequate alpha-blockade and beta-blockade), Cushing's syndrome from adrenal adenoma, adrenal incidentaloma with functional or malignant features, and lesions <6 cm without evidence of invasiveness.

Patient Position: Full lateral decubitus (affected side up) with the table flexed.

Anaesthesia: General. For phaeochromocytoma: specialist anaesthetic team with arterial line, Foley catheter, and vasoactive drugs immediately available.

Prophylactic Antibiotics: Per local protocol.

Ports: Three to four ports on the ipsilateral flank (transabdominal lateral approach, or retroperitoneal approach).

Procedure (Right Adrenalectomy — Transabdominal Lateral):
1. Pneumoperitoneum established. Right lobe of liver retracted medially.
2. Right triangular ligament of the liver divided.
3. Peritoneum lateral to the inferior vena cava (IVC) incised. Adrenal gland identified superior to the right kidney.