Right adrenalectomy, open

Anatomy Perioperative management Technique Complications Evidence Total Video Medical Equipment

Content

Laparotomy and exploration
Kocher maneuver mobilizing the duodenum
Exposing the right retroperitoneum and mobilizing the liver
Exposing the inferior vena cava
Separating right adrenal and kidney
Transecting the adrenal vein
Posterocaval dissection of the adrenal tumor
Specimen removal
Closing the diaphragm and sealing the liver
Drainage and closing the abdominal wall

Authors

Laparotomy and exploration

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Transverse right laparotomy at the level of the umbilicus. After transecting the right rectus muscle with bipolar scissors and opening the peritoneum extend the incision in the midline to the xyphoid process. Explore the intestinal organs to rule out other metastases and confirm resectability.
Kocher maneuver mobilizing the duodenum

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Depending on the conditions in the field the right colic flexure may have to be freed. Follow this by mobilizing the descending duodenum until the inferior vena cava is exposed along its full length.
Exposing the right retroperitoneum and mobilizing the liver

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The posterior aspect the right adrenal abuts the diaphragm. The inferior aspect contacts the right kidney and the anteriosuperior aspect borders on the nude area of the liver. The anteromedial aspect of the right adrenal is posterior to the inferior vena cava. Paralleling the inferior vena cava open up the parietal peritoneum covering the anteroinferior aspect of the right adrenal.
Transect the right triangular ligament before retracting the liver craniad. Now transect the adhesions between the inferior aspect of the liver and the adrenal. The perineoplastic inflammatory reaction will have resulted in intimate contact.
Note: Surgical procedures on the right retroperitoneum are more difficult than on the left side because enlargement of the liver, obesity and barrel chest may make visualization and control of the surgical field quite difficult.