This video demonstrates Laparoscopic Resection Myolipoma of Adrenal Gland performed at World Laparoscopy Hospital. The giant adrenal myelolipoma is a rare tumor. Laparoscopic adrenalectomy has become the gold standard in the management of most adrenal masses. Even for giant adrenal masses, it can be done in a safe way, provided that is performed by an experienced laparoscopic team.

Myolipoma of the adrenal gland is an extremely rare, benign mesenchymal tumor composed of mature adipose tissue and smooth muscle fibers. Although adrenal myolipomas are non-functional and often asymptomatic, they are frequently detected incidentally due to the widespread use of imaging modalities such as ultrasonography, CT scan, and MRI. Surgical intervention becomes necessary when the lesion is large, symptomatic, or when malignancy cannot be ruled out. Laparoscopic adrenalectomy has emerged as the preferred approach due to its minimal invasiveness and excellent clinical outcomes.

Epidemiology and Pathology

Adrenal myolipomas are uncommon and differ from the more frequently encountered adrenal myelolipomas. Histologically, myolipomas consist predominantly of smooth muscle cells interspersed with mature fat tissue, without hematopoietic elements. These tumors are typically well-encapsulated and benign, with no malignant potential reported in the literature.

Clinical Presentation

Most patients remain asymptomatic, and tumors are discovered incidentally during radiological evaluation for unrelated conditions. Symptomatic patients may present with:

Flank or abdominal pain

Abdominal fullness

Compression symptoms involving adjacent organs

Hormonal evaluation usually reveals non-functional lesions, but a complete endocrine work-up is essential to exclude functional adrenal tumors.

Diagnostic Evaluation

Radiological imaging plays a crucial role in diagnosis:

CT Scan: Shows a well-defined adrenal mass with fat-density components and soft tissue elements.

MRI: Helps differentiate fat-containing tumors and assess local invasion.

Despite advanced imaging, definitive diagnosis often requires histopathological examination after surgical excision, as imaging findings may overlap with other adrenal tumors such as liposarcoma or angiomyolipoma.

Indications for Surgery

Laparoscopic resection is recommended in the following scenarios:

Tumor size greater than 4–6 cm

Presence of symptoms

Rapid tumor growth

Diagnostic uncertainty or suspicion of malignancy

Surgical Technique: Laparoscopic Adrenal Resection

Laparoscopic adrenalectomy can be performed via a transperitoneal or retroperitoneal approach. The transperitoneal route is commonly preferred due to better anatomical exposure.

Key surgical steps include:

Patient positioning in lateral decubitus position

Creation of pneumoperitoneum and strategic port placement

Mobilization of surrounding organs (liver, spleen, or colon depending on side)

Identification and early control of the adrenal vein

Careful dissection and complete excision of the tumor with the adrenal gland

Specimen retrieval using an endoscopic bag

Meticulous hemostasis and preservation of surrounding structures are essential.

Postoperative Care and Outcomes

Patients undergoing laparoscopic adrenal resection generally experience:

Minimal postoperative pain

Early ambulation

Short hospital stay

Excellent cosmetic outcomes

Histopathology confirms the diagnosis of myolipoma. Long-term prognosis is excellent, with no reported recurrence following complete excision.

Advantages of Laparoscopic Approach

Reduced surgical trauma

Less blood loss

Faster recovery

Lower postoperative complications

Superior visualization of adrenal anatomy

Conclusion

Laparoscopic resection of adrenal myolipoma is a safe, effective, and minimally invasive surgical option. With proper patient selection and adherence to surgical principles, excellent outcomes can be achieved. As imaging techniques advance, incidental detection of rare adrenal tumors is increasing, further emphasizing the role of laparoscopy in modern adrenal surgery.