Case history:
A 26 year aged obese (BMI 32.5) female patient had come to OPD with the complaints of left upper abdominal pain for last 3 months. She had a dull aching pain which was not associated with any aggravating and relieving factors. She initially underwent an USG whole abdomen which revealed a suprarenal (Adrenal gland) mass on the left side. A contrast CT scan revealed a 4.5×5 cm Sol (tumor) in the left adrenal gland with calcification and necrotic areas. Metabolic work up was normal.
She underwent a laparoscopic Adrenalectomy under General Anaesthesia.
Two very small incisions (cuts) of 10mm and one 5 mm were made on her abdomen. The adrenal mass was oval shaped and had adhesions with the intestine and kidney. Tail of pancreas was also very close to it. Despite such difficulties the procedure was completed without any complications. Mass was then removed through one of the 10mm small incision. Post-operative period was uneventful as drain was removed on post-operative day 2. Patient’s pain score was very low and was extremely happy with her treatment.
Fig 1: Port positions in Laparoscopic Left Adrenalectomy
Fig 2: Laparoscopic dissection of Left Adrenal Vein and Adrenal SOL
Discussion:
Since its inception in 1992, laparoscopic adrenalectomy has been attempted in various adrenal gland lesions. Some of the common indications are adrenal incidentaloma, pheochromocytoma, Cushing’s syndrome etc. Mass of size more than 8cm or suspected malignant lesions are often operated via open surgery. Advantages of such a minimal invasive surgical procedure are;
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- It can be performed by 3-4 very small incisions on the abdomen
- Less pain
- Small scars and better cosmetic results
- Decreased hospital stay
- Shorter recovery time
- Early ability to join work and
- Improved patient satisfaction.
However the critical location of adrenal gland including its vascular supply is often a hindrance to successful completion of surgery laparoscopically.
Such minimally invasive surgery can also be performed for other urological diseases like Renal tumors, non-functioning kidney, Pelviureteric junction obstruction, ureteric stones etc.
Dr. Chandra Sekhar Patro & Dr. Bikram Haldar
Consultant, Urology, Narayana Multispeciality Hospital, Jessore Road.