چکیده (انگلیسی):

Background/Objective: Standard laparoscopic adrenalectomy requires early control
of the main adrenal vein; however, the small retroperitoneal working space is challenging for
beginners to perform this maneuver. We report a technical modification of retroperitoneal laparoscopic
adrenalectomy (RLA) for primary hyperaldosteronism (PHA) and the clinical outcomes.
Methods: A total of 38 RLAs were performed for the patients with PHA. The patients were placed in
true lateral position with mild bending to expand the surgical field. Instead of attempting to
control the main adrenal vein initially, we adopted a technical modification that manipulating
and freeing the gland first before controlling the main adrenal vein.
Results: The RLAs were successfully performed in all but one case, which was converted to open
surgery due to pancreatic injury. Mean operative time was 124 minutes and estimated blood loss
was 74 ml. Mean maximal fluctuation of systolic blood pressure was 29 mmHg. For the right-side
RLA, less operative time (113.5 vs. 137.9 minutes) and estimated blood loss (59.5 vs. 91.2 ml) were
noted compared with the left-side procedure. Postoperative complications included cerebrovascular
accident in one patient, one surgical site hematoma, and two patients had postoperative
fever. Potassiumlevel returned to normal in all patients and 70% of the patients reduced their antihypertensives.
Conclusion: Technical modification RLA for PHA without initial control of the main adrenal vein is
a safe and feasible procedure. No vigorous blood pressure fluctuation was intraoperatively noted.
No vascular injury occurred. Moreover, the right-side procedure became easier.