In this video we present 2 cases of laparoscopic adrenalectomy for unusual adrenal lesions. The first case involves a man with a large left adrenal cyst which presented as a painful flank mass. Functional studies were normal. Pathology was consistent with a benign pseudocyst, presumably resulting from a traumatic hemorrhage in the remote past. The second case involves a woman who was incidentally noted to have a 7cm left adrenal mass on a CT scan she had for acute appendicitis. She also had no biochemical evidence of hormone production. Pathology revealed a benign leiomyoma. We discuss the workup of adrenal masses as well as technical aspects of Laparoscopic adrenalectomy. Specifically we discuss renal and adrenal venous anatomy and the indications for laparoscopic versus open adrenalectomy for various lesions.

Laparoscopic adrenalectomy can be safely performed even for lesions larger than 6 cm. Familiarity with the renal and adrenal venous anatomy can potentially avoid misidentification injuries. It is essential to obtain functional studies and appropriate imaging prior to surgery. Conversion to open is indicated for cases of local invasion.