Vascular Injury During Laparoscopic Left Adrenalectomy

Ankur Gupta, MD, Edward H Phillips, MD

Cedars Sinai Medical Center

Objective: Video case presentation of a vascular injury during laparoscopic left adrenalectomy.

Background: 25 y.o. female with persistent hypertension and mildly elevated urine normetanephrine levels at 559 was found to have a 1cm left infero-medial adrenal lesion. The patient was noted to have an abnormal MIBG scan. She was suspected to have a ganglioneuroma given the mildly elevated biochemical markers.

Results: A transabdominal laparoscopic left adrenalectomy was performed and the patient was placed in left lateral decubitus position. The adrenal vein was identified and divided. The presumed ganglion was retracted and divided. Bleeding resulted and was controlled using endoloops. The Aorta was dissected from the diaphragmatic hiatus to the left renal artery and revealed a low origination of the celiac artery with transection of the celiac trunk. Post procedure angiogram revealed excellent collateral flow from the superior mesenteric artery.

Conclusion: The importance of examining for variant arterial anatomy during left adrenal dissection. Additionally, the ability to control hemorrhage and discern aortic anatomy using laparoscopic techniques is shown.

Session: Video ChannelDay 3

Program Number: V107

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