a. Patient and Procedure Prep

b. Procedure Outline

1. Introduction

a. Patient Positioning and Preparation

b. Mark Trocar Locations

2. Surgical Approach

a. Adhesiolysis

3. Access and Placement of Ports

4. Splenic Flexure Takedown

5. Exposure of Adrenal Gland

a. Adrenal Vein Ligation

6. Adrenal Gland Dissection and Removal

7. Closure

8. Examination of Specimen

9. Post-op Remarks

Primary hyperaldosteronism refers to the autonomous secretion of the hormone aldosterone from the adrenal gland, resulting in low renin levels. This usually occurs in individuals between the ages of 30 to 50 years old. The majority of these cases are caused either by a solitary, functioning adrenal adenoma or aldosteronoma (70%) or by idiopathic bilateral hyperplasia (30%). Other uncommon causes include adrenal carcinoma and familial hyperaldosteronism. Patients typically present with hypokalemia and long-standing hypertension that is difficult to control despite multi-drug therapy; nevertheless, further tests are required for diagnosis. An elevated plasma aldosterone level with a suppressed plasma renin level is strongly suggestive of the diagnosis. Once confirmed, further evaluation should be directed toward determining if the cause is a unilateral aldosteronoma or bilateral adrenal hyperplasia. This is done through imaging studies and adrenal vein sampling. Unilateral aldosteronoma is best managed by adrenalectomy, with the laparoscopic approach being the preferred method. Bilateral adrenal hyperplasia is often best treated medically because only 20–30% benefit from surgery. Here, we present the case of a 48-year-old woman who had long-standing hypertension and hypokalemia and was found to have hyperaldosteronism and low renin levels. A CT scan showed a small mass in the left adrenal gland, and adrenal vein sampling showed higher levels of aldosterone on the left side than on the right, confirming a unilateral aldosteronoma. Laparoscopic access was gained, the adrenal gland was exposed and dissected by controlling the periadrenal tissues with the harmonic scalpel, the adrenal vein was then ligated, and the adrenal gland was removed.

Watch this full-length, surgical video of a left laparoscopic transperitoneal adrenalectomy for an aldosteronoma performed by Dr. Richard Hodin at MGH.

Massachusetts General Hospital

Left Laparoscopic Transperitoneal Adrenalectomy for Aldosteronoma

0182_PrintPass_V5_Josh_20230613

0182 - Hodin

Left Laparoscopic Transperitoneal Adrenalectomy for Aldosteronoma | Journal of Medical Insight

DOI
Publication Date	2023/06/23
Article ID	182
Production ID	0182
Volume	2023
Issue	182
https://doi.org/10.24296/jomi/182

Procedure Outline

Table of Contents