Radiology 2003; 229:581-586.
Hurley ME, Herts BR, Remer EM, Dylinski D, Gill IS.
Use of three-dimensional (3D) volume-rendered helical computed tomography (CT) in surgical planning before laparoscopic adrenalectomy was evaluated in a retrospective study. In 35 consecutive patients before laparoscopic adrenalectomy, 3D volume-rendered CT scans were created from helical CT scans. Videotapes that showed anterior, lateral, posterior, and posterocephalic approaches were assessed retrospectively. The relationship (not contacting, abutting, displacing, or invading) of adrenal masses to adjacent organs (diaphragm, liver, spleen, kidneys, stomach, pancreas, and vessels) was recorded and compared with findings in surgery reports. When such findings were available, they corresponded to those in the videotape. Three-dimensional volume-rendered CT successfully displayed the relationship of adrenal masses to adjacent anatomic structures and organs before laparoscopic adrenalectomy.
Laparoscopic adrenalectomy was described by Gagner et al in 1992 (1) and has since found widespread acceptance as the standard minimally invasive procedure for resection of adrenal masses (2-4). Laparoscopic adrenalectomy is less invasive, has equivalent or better complication rates and, in terms of overall hospital expenses, is more cost-effective (5-8) than surgical adrenalectomy. Five laparoscopic approaches are described: anterior and lateral transperitoneal, lateral and posterior retro-peritoneal, and thoracoscopic transdia-phragmatic (9-14).
One key to diminishing surgical time and reducing complications is familiarity with the anatomy at surgery (15). Radio-graphic findings that confirm laparoscopic resectability are inclusion of fat planes between the adrenal gland and inferior vena cava or aorta, exclusion of local invasion into adjacent organs, and exclusion of venous thrombus (2). Knowledge of the position and longest dimension of the adrenal gland and the position of the adrenal lesion relative to adjacent diaphragm or organs is important to the success of the procedure because it facilitates dissection, allows the surgeon to anticipate potential complications, and helps the surgeon choose the best approach. Three-dimensional (3D) CT can simulate the dissection from any potential laparoscopic approach.
Computed tomography (CT) and magnetic resonance (MR) imaging of the adrenal glands have been used traditionally to localize hyperfunctioning adrenal neoplasms and to characterize adrenal masses found either incidentally or as part of a staging evaluation in patients with a primary neoplasm (16-21). CT and MR imaging have also been used for surgical planning in a number of areas in the abdomen: laparoscopic donor nephrectomy (22,23), partial nephrectomy (24-27), and living related liver donor resection (28). The purpose of this retrospective study was to evaluate the use of 3D volume-rendered helical CT in surgical planning before laparoscopic adrenalectomy.