The adrenal gland is hypervascular and friable. The adrenal glands vie with the thyroid gland for having the greatest blood supply per gram of tissue. The arterial supply is very rich. Unlike the left adrenal gland, the right adrenal gland rarely extends downward to the renal pedicle. The spleen, splenic capsule, splenic vessels, and the tail of the pancreas are enveloped by the splenorenal ligament. Both the kidney and the gland are covered with renal fascia.
In primary aldosteronism, meticulous attention to hemostasis is essential. Hematomas from operative trauma may disguise or mimic adenoma. Step-by-step technique is provided for exposure and mobilization of the adrenal gland and the many adrenalectomy procedures. With laparoscopic adrenalectomy, the transabdominal lateral approach provides the best overall view of the areas of dissection and surrounding structures.