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Right adrenalectomy, open - general and visceral surgery
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Laparotomy and exploration
Kocher maneuver mobilizing the duodenum
Exposing the right retroperitoneum and mobilizing the liver
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.
Exposing the inferior vena cava
Separating right adrenal and kidney
Transecting the adrenal vein
The most important landmarks are the inferior aspect of the liver and lateral margin of the inferior vena cava. Dissection along the lateral margin of the inferior vena cava will lead to the right adrenal vein.
Usually, only via a single vein drains the blood from the right adrenal into the suprarenal vein. This vein exits the adrenal at the anterior aspect of the gland. The right adrenal vein courses just a small distance before it drains directly into the inferior vena cava.
Posterocaval dissection of the adrenal tumor
Closing the diaphragm and sealing the liver
Drainage and closing the abdominal wall