ABSTRACT
The transperitoneal approach to laparoscopic adrenalectomy is indicated for the removal of non-functional and functional solid adrenal masses of small to intermediate size. This includes masses of the adrenal cortex – aldosteromas, glucocorticoid-, androgen-, and estrogen-producing adenomas, solitary small pheochromocytomas, hormone-inactive lesions larger than 3 cm that demonstrate growth over time on serial imaging studies, tumours larger than 4–5 cm without observation, adrenal cysts or myelolipomas, and selected cases of bilateral adrenal hyperplasia. Special indications are the removal of malignant tumors or metastases. The criteria for performing laparoscopic surgery on these tumors include controllability of the primary cancer, resectability of any other metastatic lesion, and physical fitness of the patient to tolerate general anesthesia. The trocars are placed in a mirror image as for the leftsided adrenalectomy. The liver retractor is inserted by the subxyphoidal trocar.
