Laparoscopic extirpation of giant adrenal ganglioneuroma
A 33-year-old female presented to us with left flank pain and ultrasonography suggestive of left suprarenal mass. Present and past medical history was unremarkable. Computed tomography (CT) scan revealed a large left suprarenal mass which was well-marginated with homogenous low CT attenuation, non-enhancing, and free from surrounding structures []. Preoperative endocrine evaluation was normal. A diagnosis of non-functioning suprarenal tumor probably benign was presumed. Definitive extirpation was planned through laparoscopic approach.\nPatient was positioned in right lateral decubitus. Access was obtained through transperitoneal route. Four ports were utilized. A large suprarenal mass was identified encroaching medially beyond the medial border of aorta, superiorly abutting the diaphragm, laterally extending up to the parietal wall and displacing the kidney inferiorly []. Peritumoral plane was defined and dissection was carried out along this plane. Spleenopancreatic complex was released from lateral attachments and surface of tumor using harmonic scalpel through 5 mm lateral port. Dissection was continued with meticulous attention to hemostasis []. The adrenal vein was identified and control was achieved at the confluence with left renal vein. A plane of cleavage was defined between the aorta and the neoplasm and the attachments were freed along this plane. The lesion could be completely extirpated laparoscopically. Duration of surgery was 250 minutes. Estimated blood loss was 230 milliliters. Specimen was extracted through pfannenstiel incision. No significant intraoperative or postoperative happenings were recorded. Patient tolerated orals on first postoperative day. Drain was removed on the second day and the patient was sent home on the following day. On gross inspection, the specimen appeared bosselated with intact capsule measuring 17 × 11 × 7.5 cm []. Microscopic features were suggestive of GN, mature subtype of adrenal gland.