Surgical Maneuver and Tactics of Using the Inferior Phrenic Vein as a Landmark in Retroperitoneal Laparoscopic Left Adrenalectomy.

Abstract

Identification and control of the central adrenal vein (CAV) are key steps in laparoscopic adrenalectomy. However, the retroperitoneal laparoscopic left adrenalectomy (RLLA) lacks identifiable anatomical landmarks and does not have advantage of quickly exposing CAV. Here, we developed surgical maneuver and tactics of using the inferior phrenic vein (IPV) as a landmark in RLLA. During operations, we searched for the IPV between superior margin of renal artery and anterior aspect of psoas major muscle, and then the left IPV was followed and applied as an anatomical landmark to identify the CAV. Moreover, our study showed that variations in the left adrenal venous anatomy occurred in cases with pheochromocytomas. The application of left IPV as a landmark to search for CAV has important clinical significance in RLLA.