Liver Mobilization Technique for right adrenal

Optimization of surgical technique has been an important component in reducing the morbidity and mortality associated with the procedure in the postoperative period. Even though minimally invasive techniques for adrenalectomy have been employed in many surgical centres, there is a need of surgeons and trainees to be confident with open adrenalectomy. Patients with large adrenocortical tumors (>6-8 cm) and those with CT suspicion of being locally invasive with adrenocortical cancers should undergo surgery with an open approach. Adequate exposure for a large right adrenal tumour is always challenging. On many occasions, the tumour may be adherent to the vena cava, involve the right liver segments or may be functional/ highly vascular. In such situations, the traditional liver mobilization entails a high risk of bleeding, tumour rupture, liver laceration, or uncontrolled hypertension due to handling of the tumour. The appropriate approach in these could be an anterior hepatectomy approach with liver hanging manoeuvre.

手术技术的优化一直是降低术后并发症及死亡率的重要环节。尽管在许多手术中心已采用肾上腺切除术的微创技术，但外科医生和实习生仍需对开放式肾上腺切除术充满信心。对于患有大型肾上腺皮质肿瘤（直径大于6-8厘米）及经CT检查怀疑肾上腺皮质癌局部侵犯的患者，应采用开放式手术方法。对于大型右侧肾上腺肿瘤的充分暴露始终是一项挑战。在许多情况下，肿瘤可能附着于下腔静脉，侵犯右侧肝段，或具有功能性和高度血管化。在这些情况下，传统的肝脏移动术可能带来出血、肿瘤破裂、肝脏撕裂或因肿瘤处理不当导致的血压失控等高风险。针对此类情况，前肝叶切除术及肝脏悬挂手法可能是恰当的处理方式。