This case series describes a unilateral laparoscopic technique for removing a noninvasive adrenal tumor in 7 dogs. All dogs were diagnosed with adrenocortical carcinoma. Dogs were positioned in lateral recumbency, and the affected side was prepared for 4 portals located in the paralumbar fossa. The portals were used for the laparoscope, instruments, a self-retaining retractor, and suction device. A small window in the capsule was used to aspirate the necrotic semiliquid content at the center of the gland by using an irrigation-suction unit. No evidence of gross metastasis was found in any of the dogs during surgery, and hemostasis was controlled during every procedure using standard bipolar cautery. Two dogs died immediately after surgery from dyspnea associated with alveolar infiltrates and pleural effusion. Of the 5 dogs that were discharged, 2 survived for 7 and 12 months from surgery, and 3 are still alive at 24, 19, and 14 months after surgery. This is similar to the mean survival time for dogs with adrenocortical tumors treated by adrenalectomy via celiotomy (20 to 22 months). Advantages of the laparoscopic procedure include magnification of the structures, which is especially useful during dissection between the right adrenal gland and the caudal vena cava; reduced risk for dehiscence and postoperative wound complications; shorter hospitalization; and decreased postoperative pain.
COMMENTARY: Laparoscopy is becoming more common in private practice, even in clinics without boarded surgeons. It is used in dogs and cats for common biopsy procedures, as well as ovariohysterectomies or gastropexy procedures. It is exciting to think that this procedure is going to be more widely available to practitioners and perhaps even available to the most expert private practitioner who is already skilled in laparoscopic techniques.
Laparoscopic adrenalectomy for treatment of unilateral adrenocortical carcinomas: Technique, complications, and results in seven dogs. Pelaez M, Bouvy G, Dupre G. VET SURG 37: 444-453, 2008.