外科ジャーナル

Laparoscopic Left Adrenalectomy for a Left Corticosteroid-Producing Adrenal Tumor

Abstract

Radu Mircea Neagoe, Daniela Tatiana Sala and Titus Cvasciuc

Cushing Syndrome (CS) is a chronic condition due to sustained exposure to glucocorticoid excess. Most frequent clinical manifestations are obesity, “moon face”, muscle weakness, osteoporosis, menstrual irregularities, high blood pressure, diabetes. Sometimes the signs and symptoms are overt (subclinical Cushing Syndrome). The most frequent tests used are 24 hours urinary free cortisol, dexamethasone suppression tests, plasma ACTH levels as well as CT/ MRI to localize the adrenal tumor. The surgical treatment is adrenalectomy. This video present a left laparoscopic adrenalectomy for a CS secondary to a left adrenal adenoma. The patient is placed in a right lateral position. Operative steps are: mobilization of the left colon, mobilization of the spleen and tail of the pancreas by dividing the splenoparietal ligament, division of the splenorenal ligament, identification of the adrenal vessels, dissection of the adrenal gland (starting medial, continuing posterior and ending lateral on the surface of the kidney) and extraction of the specimen in an endobag. Postoperative follow-up was uneventful. CONCLUSION: In our opinion laparoscopic adrenalectomy is the gold standard procedure for adrenal CS.