1. Introduction

a. Mark Trocar Positions

b. Inject Local Anesthetic

2. Surgical Approach

a. Incision

b. Hasson Port Placement

c. Insufflation

d. Laparoscopic Abdominal Cavity Exploration

e. Placement of Ports

f. Adhesiolysis

3. Access and Placement of Ports

a. Mobilization of Right Lobe of Liver Through Division of Triangular Ligament

b. Peritoneal Incision and Dissection Towards Psoas Muscle

4. Adrenal Gland Exposure

a. Right Adrenal Vein Identification, Clipping, and Division

b. Final Check for Hemostasis

5. Right Adrenal Gland Dissection

6. Adrenal Gland and Ports Extraction

7. Gross Examination of Specimen

8. Closure

9. Post-op Remarks

Primary hyperaldosteronism, or Conn's syndrome, is a disease in which one or both adrenal glands produce excess amounts of aldosterone, leading to hypertension and hypokalemia. Common conditions resulting in this disorder include adenoma of the adrenal gland or hyperplasia of both adrenal glands. In rare cases, it is caused by malignant growth in the adrenal cortex or familial hyperaldosteronism. High blood pressure may cause headaches or blurred vision. Low potassium may cause fatigue, muscle cramps, muscle weakness, numbness, or temporary paralysis.

Primary hyperaldosteronism is diagnosed by measuring serum levels of aldosterone, renin, and potassium. Patients classically have high aldosterone levels, suppressed renin levels, and low potassium levels. Once the diagnosis is established, the localization of the source is performed using imaging studies. Adrenal vein sampling is also performed to determine more precisely and directly the side that is producing excess aldosterone.

Primary hyperaldosteronism caused by an adrenal gland tumor is treated with adrenalectomy. Approximately 95% of patients will notice a significant improvement in their hypertension after successful surgery. Here, we present the case of a 58-year-old female with hypokalemia and long-standing hypertension refractory to medical treatment. Her blood tests showed high aldosterone levels and low renin levels, confirming the diagnosis of hyperaldosteronism. On CT scan, an adrenal nodule was noted on both sides. Adrenal vein sampling identified the right adrenal nodule as the cause. Laparoscopic access was gained, the adrenal gland was dissected and exposed, the adrenal vein ligated, and the adrenal gland was removed.

Watch this full-length, narrated surgical video of a transperitoneal right adrenalectomy for cortical adenoma performed by Dr. Richard Hodin at MGH.

Massachusetts General Hospital