Laparoscopic Left Adrenalectomy for Large 14 cm Pheochromocytoma

Alexander Shifrin, MD; William Inabnet, MD; Joseph Grossman, BS

Product Details
Product ID: ACS-2526
Year Produced: 2006
Length: 15 min.

This video will demonstrate the technique of laparoscopic left adrenalectomy for a large left pheochromocytoma and will provide technical pearls for dealing with large adrenal tumors. The patient is a 42 year old male with an 8 year history of cluster headaches who presented with an acute myocardial infarction and severe hypertension. His workup included urinary chatecholamines which revealed the following: norepinephrine = 2483, epinephrine = 4274 and metanephrine = 39,000. Abdominal CT scan showed a 14 cm left adrenal mass with internal hemorrhage. Due to the concern of malignancy, a MRA was performed which showed patent renal vasculature with no evidence of periadrenal invasion. MIBG scanning showed intense uptake in the left adrenal gland with no evidence of extra-adrenal disease. After appropriate cardiac clearance and preoperative preparation, laparoscopic adrenalectomy was performed 6 weeks after initial presentation. Intraopertaive ultrasound was used to determine resectability. Technical challenges included finding the left adrenal vein, dissecting the left renal vein, identifying atypical venous anatomy, and safely mobilizing the mass using a "no touch" technique. There were no hemodynamic events during surgery. Laporoscopic adrenalectomy for large pheochromocytoma can be performed safely with proper preoperative evaluation/preparation and meticulous surgical technique.