Laparoscopic appreciation of the adrenal artery: fact or fiction?

Abstract:

BACKGROUND:It is well accepted that identification and control of the adrenal vein is a critical step in laparoscopic adrenalectomy. The surgical and anatomic literature propagates the notion of a dominant or multiple dominant adrenal arteries that should likewise be controlled during surgical extirpation. MATERIALS AND METHODS:We assessed the frequency of adrenal-artery identification and the need for formal ligation in an extensive series of laparoscopic adrenalectomies. RESULTS:In our experience, even using a magnified laparoscopic view, we found it possible to identify and necessary to formally ligate an adrenal artery in only 3 of 265 cases (1.1%). Further, in this series, only the inferior adrenal artery was ever seen definitively to require formal clip ligation, while a discrete middle or superior adrenal artery was almost never seen, and the vasculature in these areas could be controlled with electrocautery or ultrasonic energy alone during routine dissection. CONCLUSIONS:The need to search for and ligate the arterial supply during laparoscopic adrenalectomy is not as clinically significant as once thought, and formal control appears unnecessary unless the vessels are serendipitously encountered during the routine dissection.

journal_name

J Endourol

journal_title

Journal of endourology

authors

Joel AB,Rubenstein JN,Arredondo S,Meng MV,Duh QY,Stoller ML

doi

10.1089/end.2005.19.793

subject

Has Abstract

pub_date

2005-09-01 00:00:00

pages

793-6

issue

7

eissn

0892-7790

issn

1557-900X

journal_volume

19

pub_type

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