Removal of large adrenal tumor on the right side with liver mobilization

Twenty-one patients with large adrenal tumor on the right side were operated on at Yamagata University Hospital. Bilateral anterior subcostal incision with a vertical midline incision extending from the xiphoid and subsequent use of self-retraction system provided satisfactory exposure of anterior liver and diaphragma area. Successive retraction of the liver exposed the right adrenal tumor and its vascular pedicles. 14 (66.7%) of the 21 patients received right adrenalectomy with liver mobilization, and 7 (33.3%) received right adrenalectomy without mobilizing the liver. Despite the average weight of removed tumors was 152.9% (p < 0.01) greater in the liver mobilized group than in the liver nonmobilized group, the incidence of good exposure of right adrenal central vein including adjacent organs was higher in the former group. In addition, incidence of blood transfusion was identical in both groups. Although postoperative liver function was slightly impaired in the liver mobilized group as compared with the liver nonmobilized group, all examined valuables manifesting liver function in the former group returned to preoperative levels within 3 weeks. The operative procedure described above appears to be useful for the removal of right large adrenal tumors with less risk of serious accident.