Bilateral Laparoscopic Subtotal Adrenalectomy via a Retroperitoneal Approach

Guy Jensen, MD, MPH; Shinjiro Hirose, MD, FACS; Michael Campbell, MD; Jacob T. Stephenson, MD, FACS; Rebecca R. Stark, MD; Payam Saadai, MD

Product Details
Product ID: ACS-5639
Year Produced: 2018
Length: 6 min.


A 13-year-old girl presented to our multidisciplinary team with strong family history of endocrine malignancies. The patient's mother was diagnosed with bilateral pheochromocytomas, an islet cell tumor of the pancreas, a C3 spinal hemangioma, and bilateral renal cell carcinoma. In addition, her maternal grandmother was diagnosed with multiple pheochromocytomas and ocular disease leading to bilateral blindness. Genetic testing was performed, and the patient was found to have Von-Hippel Lindau syndrome. She was followed with annual retinal exams, audiology visits, and abdominal ultrasounds. At the age of 16, she underwent screening abdominal MRI, which demonstrated bilateral adrenal nodules measuring 1.3 cm and 0.8 cm on the right and left respectively. Her serum metanephrines were 0.19 nmol/L. Subsequent MIBG imaging revealed intense radiotracer uptake within the bilateral adrenal glands consistent with bilateral pheochromocytomas. She was normotensive and asymptomatic. She was evaluated by a multidisciplinary team of surgeons and endocrinologists. The discussion focused 1) continued observation secondary to her lack of symptoms and concern for preserving her adrenal function during her adolescent skeletal development 2) bilateral adrenalectomies to reduce the risk of hypertensive crisis and minimize the risk of recurrent pheochromocytoma or 3) perform bilateral cortical sparing adrenalectomies to maintain cortical function, but accept the risk of recurrent pheochromocytoma. Ultimately, the patient underwent a successful laparoscopic bilateral cortical sparing adrenalectomy via a retroperitoneal approach. Although recurrence is likely, this approach allows for a future transabdominal laparoscopic approach when it becomes necessary while preserving adrenal cortical function to maximize skeletal development during adolescence.