Objective: To summarize our experiences in the retroperitoneoscopic
adrenalectomy (RPA) for adrenal lesions close to vena cava.
Methods: We retrospectively analyzed the clinical data of 1278
consecutive patients who had undergone RPA from September
2005 to October 2011, among whom 138 had adrenal tumors
close to vena cava. All the lesions were located in the right side.
During surgery, the internal part of the adrenal gland closing to
the retroperitoneum was liberated firstly, and the whole adrenal
gland was dissected along the inferior vena cava completely.
Results: Mortality was zero. There were no obvious perioperative
complications except 4 cases of perforation of the retroperitoneum
intraoperatively in the case of pheochromocytoma. Adrenal
tumors averaged 3.6 cm (range, 1.2-6.5 cm), including 90 cases of
primary hyperaldosteronism (80 adenomas and10 Hyperplasia),
20 nonfunctional adrenal adenomas, 10 Pheochromocytoma, and 8
Cushing's syndrome. The mean operative time was 75 min (35-145
min), mean estimated blood loss 100 mL (50-250 mL), and mean
postoperative hospital stay 4 d (3-7 d). Follow-up (5 -38 months)
showed no recurrence.
Conclusions: CT angiography or MR angiography should be performed preoperatively to evaluate the whole blood
supply of the adrenal tumor. If local invasion is detected by the
preoperative imaging, laparoscopic treatment is no longer a
preferred option. The adrenal tissue close to vena cava must be
dissected with extreme care, and a laparoscopic vascular clamp
must be ready for emergency lateral clamping of the vena cava,
and also prepare sufficiently in case of the conversion to open