The transperitoneal laparoscopic approach for right adrenalectomy is performed in patients placed in a lateral decubitus position. Four ports are usualy needed (2 or 3, 10 mm, ports, 1 or 2, 5 mm, ports), inserted in the right subcostal area. After liver retraction, the retroperitoneal space is opened close to the liver, exposing the right adrenal gland and the inferior vena cava. The periphrenic fat and the internal side of the gland are dissected close to the right side of the vena cava in order to expose the main adrenal vein. This vein is double clipped. At the inferior pole of the gland, the inferior adrenal artery is ligated with clips. Before removing and extracting the gland, the right side and the upper pole of the gland are dissected last. (C) 2003 Editions scientifiques et medicales Elsevier SAS. Tous droits reserves.
