[Retroperitoneal laparoscopic adrenalectomy. The 3-trocar surgical technic]

Laparoscopic adrenalectomy (LA), introduced in surgical practice quite recently, proves to be an effective method for treating diseases of the adrenal gland on account of the good visualization provided, in conjunction with all additional advantages of laparoscopic surgery, such as reduced traumatism, postoperative pain alleviation, shortened hospital stay and the like. Two patients presenting Cushing's syndrome are subjected to retroperitoneal laparoscopic adrenalectomy (RLA). With the patient in lumbotomy position on the operating table, a retroperitoneal space is created using a balloon dissector (Ethicon). The optics is introduced after placing a 10 mm balloon trocar (Origin). Under visual control two additional 10 mm trocars are placed along the course of lumbotomy line, accordingly along the anterior and posterior axillary lines. Next blunt dissection of the adrenal gland is done, and a clip applied to v. centralis. The adrenal gland is removed through one of the trocars, and the operation terminates after hemostasis and insertion of a drainage tube. The patients are discharged on the 4th postoperative day in a good general condition, mobilized, well fed with restored passage. In conclusion, the assumption is warranted that the early experience with RLA is encouraging as a safe and considerably less traumatic surgical procedure for operative management of diseases of the adrenal glands.