Left Adrenalectomy:
The Told line was incised from splenic flexure to the sigmoid junction
to mobilization the left colon. After reflecting the descending colon
medially, the dissection was carried out between Gerota’s fascia and the
mesocolon up to access to the renal and adrenal vein. Dissection of the
adrenal gland before vascular control was avoided to prevent the
systemic release of catecholamines. The adrenal vein was controlled
using Hem-o-Lock clips, and dissection was continued from just superior
to the renal vein until the psoas muscle was identified. The tissue was
manipulated without directly grasping the adrenal gland to avoid
bleeding and potential hemodynamic instability. The medial dissection
was carried out from the renal vein to the crus of the diaphragm. An
ultrasonic scalpel was used to control small vessels. Once the medial
dissection was completed, lateral dissection was extended between the
renal cortex and perinephric fat adjacent to the adrenal gland. The
specimen was removed using an endopouch.