Perhaps no organ is better suited for laparoscopic surgery than the adrenal gland because of its small size and relatively difficult location in the retroperitoneum, which requires a large, open excision for extraction. Since its first description by Gagner et al in 1992, laparoscopic adrenalectomy has become increasingly used and now has become the technique of choice for most benign adrenal lesions because of the decreased blood loss, lower morbidity, shorter hospitalization, faster recovery, and overall cost-effectiveness in comparison with the open approach.
Because of the anatomic differences between the right and left adrenal glands, most notably the different venous drainage patterns, surgical approaches are somewhat different for right and left adrenalectomy. Although laparoscopic right adrenalectomy is generally believed to be more difficult because of the proximity of dissection to the inferior vena cava and duodenum and the short adrenal vein, one review of laparoscopic left and right adrenalectomies reported no difference in complication or conversion rates between the two, with shorter operative times for the right. Despite the similar outcomes reported, technical strategies and anatomy differ between laparoscopic right and left adrenalectomies and should be recognized by surgeons performing these procedures.
