Indications

• Phaeochromocytoma
• Adrenal carcinoma / adenoma
• Non functioning incidentaloma > 4cm in diameters (risk of malignancy)
• Failure of medical therapy

Considerations (if for phaeochromocytoma)

- Alpha blockade (doxazosin)
- Beta blockade (atenolol)

Right adrenalectomy

1. Supine + GA + Prepare/drape
2. Transverse supra-umbilical incision made with upward convexity
3. Access adrenal gland
   • Mobilise right colic flexure, retract downwards, retract liver upwards
   • Incise posterior peritoneum above level of upper pole of right kidney
   • Expose IVC, right adrenal gland
4. Dissect / remove adrenal gland
   • Separate from kidney and perinephric fat / fascia
   • Dissect off IVC
   • ligate vessels
   • Dissect out
5. Ensure haemostasis
6. Close wound in layers

Post-operative considerations

• 30mg po hydrocortisone/day
• Fludrocortisone 0.1mg/day