drawn through and sewn to the skin with fine chromic or silk sutures. The wound is
drained, closed, and dressed. An ileostomy bag is placed over the stoma.
The surgeon may do a cystectomy either before or after this procedure. In
some cases, he may choose to leave the bladder rather than subject a
debilitated patient to further surgery.
a. General. This operation involves the partial or total excision of one or both
adrenal glands. This procedure may be done to treat hyperfunction of the adrenals,
remove tumors of the glands themselves, or treat tumors elsewhere in the body that are
affected by adrenal hormonal secretions, such as carcinoma of the prostate or breast.
b. Patient Preparation. For unilateral adrenalectomy, the patient may be
placed in the lateral kidney or supine position. More often, however, both glands are
explored, and the supine position is selected.
c. Operative Procedure--Lateral Approach.
(1) An incision curving from the midline and extending from the rib cage to
the iliac crest is made with the scalpel through the skin, fat, and muscle. The
lumbodorsal fascia is cut to reveal the sacrospinal muscle. This muscle is detached
from the ribs, using forceps and dissecting scissors.
The rib is resected.
(3) An opening is made through the transverse fascia with scissors. The
pleura and diaphragm are protected with wet pads, and Gerota's capsule is incised to
expose the kidney and adrenal gland.
(4) The gland is dissected free, using scissors and Babcock forceps. The
blood supply of the gland is identified, clamped or clipped, and divided. Bleeding
vessels are ligated. To release the glands, the left adrenal vein, a branch of the left
renal vein, is separated by clamping and cutting. The right adrenal vein, a tributary of
the vena cava, is also divided. Fine vascular sutures may be required to repair
inadvertent injury to the vena cava.
(5) When hemostasis has been assured, the wound is closed in
layers--muscle, fascia, subcutaneous tissue, and skin.
d. Operative Procedure--Abdominal Approach.
(1) The abdominal wall is incised, and the peritoneal cavity is opened and
explored. Bleeding vessels are clamped and ligated.