Experience in identifying the venous drainage of the adrenal gland during laparoscopic adrenalectomy

Abstract

Laparoscopic adrenalectomy (LA) is the procedure of choice for most adrenal tumors. An important part of LA is the early identification and ligation of the adrenal veins. The venous drainage from each adrenal gland is usually via a single vein: the right vein draining into the inferior vena cava (IVC) and the left vein into the left renal vein. Although infrequent, variable venous drainage has been documented. The aim of the study was to clarify if LA identified venous drainage and its variants. Between January 1999 and January 2008, 142 consecutive patients underwent LA. Adrenal vein anatomy was documented on a prospective database. In total, 142 patients underwent 162 LA (right = 62, left = 66, bilateral = 17). All adrenal veins were identified at the time of laparoscopy. For 157 LA, the adrenal venous drainage was constant: right vein drained into the IVC and left vein drained into left renal vein. Five patients had adrenal vein variants: two right veins draining separately into IVC (n = 1), two right veins draining into the IVC and right renal vein (n = 1), and two left veins draining separately into the left renal vein (n = 3). Adrenal vein variants were present in patients with phaeochromocytomas (n = 4) or adrenocortical carcinoma (n = 1). The laparoscopic approach allowed an excellent view of the main adrenal venous anatomy. This has helped confirm the constant nature of the venous drainage and successfully identify variant adrenal veins.

Bilateral aldosterone suppression and its resolution in adrenal vein sampling of patients with primary aldosteronism: analysis of data from the WAVES‐J study

“…There are some reports of an alternative drainage vein from an adrenal tumour. 22,23 However, there are no reports on a higher concentration of aldosterone in the alternative drainage by venous sampling in PA patients. If BAS is observed both before and after ACTH stimulation and an adrenal tumour detected by CT in a PA patient, the presence of an alternative drainage vein should be considered.…”

Variant Adrenal Venous Anatomy in 546 Laparoscopic Adrenalectomies

“…Previously reported variants of the left adrenal vein include duplication, with both the left adrenal vein and the inferior phrenic vein draining into the renal vein (n = 8) 7,12 or with 1 adrenal vein draining into the renal vein and 1 adrenal vein draining into the left lumbar vein (n = 1). 6 We found 3 patients with variant anatomy of the right adrenal vein joining an (accessory) hepatic vein.…”

“…The presence of multiple periadrenal veins has been reported before by others. 6,12 More collateral veins may become apparent as the tumor grows. This is consistent with our finding of larger tumors in patients with variant adrenal venous anatomy.…”

“…4 Variations to this pattern have been documented in cadaver studies, [5][6][7][8][9][10][11] a clinical study, 12 and a few case reports. 13,14 Anson and Caudwell 5 studied the venous drainage of the adrenal glands in 450 cadavers.…”

“…Adrenal pathology, possibly through angiogenesis or vasodilation of preexisting small collateral vessels, may increase both the variation of venous drainage and the number of periadrenal vessels. Parnaby et al 12 studied the venous anatomy encountered in 162 laparoscopic adrenalectomies for adrenal pathology. They found variant venous anatomy in 5 adrenal glands: 4 in patients with pheochromocytoma and 1 in a patient with adrenal cortical cancer.…”