[The posterior transpleural-diaphragmatic approach in adrenal pathology]

The diversity of the pathologies involving the adrenal gland have led to a variety of surgical approaches to these bodies. The deep anatomic location of the adrenals limits the surgical field. The most direct approach is the posterior lumbar, described by Young in 1936. In our experience, the posterior transpleurodiaphragmatic lumbar approach, described by Novick in 1989, has proved to be very useful for resection, particularly of the right adrenal, and does not increase the morbidity of the procedure. Our results are presented herein.

The posterior transpleurodiaphragmatic approach was utilized in 11 patients; 9 had functioning adrenal adenoma (7 Conn's primary hyperaldosteronism, and 2 Cushing's syndrome), 1 had a nonfunctioning adrenal adenoma of 5 cms and 1 had adrenal metastasis from carcinoma of unknown origin.

There were minor postoperative complications (2 seroma, 1 paralytic ileus and 1 limited atelectasis) that were resolved without difficulty.

The posterior transpleurodiaphragmatic access to the adrenal gland is a useful procedure. It requires no thoracic tube or retroperitoneal drainage, muscle incisions are minimal resulting in less discomfort postoperatively, early recovery and shorter hospitalization. For all the foregoing reasons, this surgical approach must be taken into account together with the oblique lumbar approach with resection of the 11th or 12th posterior lumbar ribs, through the pleura and the diaphragm or not, or the laparoscopic approach currently being developed.