Adrenalectomy

Multiple series have demonstrated the benefits of laparoscopic adrenalectomy techniques when compared to open surgery. Laparoendoscopic single-site surgery (LESS) for adrenal gland has been effectively performed for a number of indications and a wide variety of approaches have been described. That said, there are still obvious technical difficulties associated with LESS and, in particular, LESS adrenalectomy is regarded as a highly challenging procedure. Reduced port laparoscopic surgery has been implemented as a way of moving forward towards the path of scarless surgery by overcoming the constraints of LESS. Herein we describe the techniques for reduced port laparoscopic adrenalectomy (RPLA), in both supine and prone position. As far as the approach is concerned, both transperitoneal and retroperitoneal techniques have demonstrated similar outcomes with appropriate patient selection criteria. The anterior transperitoneal route is used with the patient is supine position. This technique can present few advantages, including easy positioning of the patient on the operative table, clear evidence of anatomical landmarks, wider exposure of the adrenal gland, early ligature of the main adrenal vein before gland manipulation, the possibility to perform a bilateral procedure, easy immediate conversion to open in the case of major bleeding. Adrenalectomy with the patient in the prone position can also be used. Overall, RPLA represents a viable option in the surgical management of adrenal diseases. Its main feature is represented by the possibility of restoring the triangulation needed to optimize working angles while minimizing the scar associated with the procedure.