Transperitoneal anterior laparoscopic adrenalectomy: the easiest technique

Four laparoscopic methods have been developed to approach the adrenal gland: anterior or lateral transperitoneal approaches, and lateral or posterior retroperitoneal approaches. The advantages and disadvantages of these methods were reviewed during a workshop held by the Japanese Society of Endourology and ESWL in 1997. The transperitoneal anterior approach, when combined with a lateral approach for the left side, is the easiest for small adrenal tumors, and discloses the adrenal vein early in the procedure. For large tumors over 5 cm in diameter, the transperitoneal lateral approach is the most feasible bilaterally. Regardless of the methods of approach, laparoscopic adrenalectomy has already become the standard procedure for adrenal tumors, because it minimizes the operative morbidity and postoperative hospital stay.