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General Surgery

Adrenal (Suprarenal) Glands

Built from Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery

What’s inside

11 sections · 146 slides

  1. 01

    Overview

    • Scope of this topic
    • Terminology used for the gland

    2 slides

  2. 02

    History of adrenal anatomy and surgery

    • Reading the historical record
    • The History of Anatomy and Surgery of the Adrenal Glands
    • The History of Anatomy and Surgery of the Adrenal Glands (continued)
    • The History of Anatomy and Surgery of the Adrenal Glands (continued)
    • The History of Anatomy and Surgery of the Adrenal Glands (continued)
    • The History of Anatomy and Surgery of the Adrenal Glands (continued)
    • The History of Anatomy and Surgery of the Adrenal Glands (continued)
    • The History of Anatomy and Surgery of the Adrenal Glands (continued)
    • The History of Anatomy and Surgery of the Adrenal Glands (continued)
    • The History of Anatomy and Surgery of the Adrenal Glands (continued)
    • The History of Anatomy and Surgery of the Adrenal Glands (continued)
    • The History of Anatomy and Surgery of the Adrenal Glands (continued)
    • The History of Anatomy and Surgery of the Adrenal Glands (continued)
    • The History of Anatomy and Surgery of the Adrenal Glands (continued)
    • The History of Anatomy and Surgery of the Adrenal Glands (continued)
    • The History of Anatomy and Surgery of the Adrenal Glands (continued)
    • The History of Anatomy and Surgery of the Adrenal Glands (continued)
    • The History of Anatomy and Surgery of the Adrenal Glands (continued)
    • The History of Anatomy and Surgery of the Adrenal Glands (continued)

    19 slides

  3. 03

    Embryogenesis of the adrenal glands

    • The two primordia of the adrenal gland
    • Timetable of medullary development
    • Formation of the neural tube and origin of neural crest cells
    • Migration of neural crest cells into the adrenal primordium
    • Development of the adrenal cortex
    • Mesothelial origin of the adrenal cortex
    • Differentiation of the cortical zones
    • Competing accounts of fetal cortex fate
    • Changing proportions of cortex and medulla with age
    • Adrenal volume from birth to adulthood
    • Volume fractions in the first postnatal year
    • Positional stability of the adrenal glands
    • Derivatives of the neural crest
    • Derivatives of the Neural Crest Cells

    14 slides

  4. 04

    Congenital anomalies and ectopic adrenal tissue

    • Classification of adrenal anomalies
    • Anomalies of the Adrenal Glands
    • Anomalies of the Adrenal Glands: remarks
    • Chief congenital anomalies of the adrenal glands
    • Agenesis of the adrenal glands
    • Fusion and hypoplasia of the adrenal glands
    • Adrenal heterotopia
    • Sites of heterotopic adrenal and chromaffin tissue
    • Accessory adrenal tissue
    • Usual site of an accessory adrenal gland on the aorta
    • Reported locations of adrenocortical and medullary tissue
    • Extra-adrenal chromaffin tissue and paraganglia
    • Anatomic distribution of extra-adrenal functional paragangliomas

    13 slides

  5. 05

    Adrenal tumours and neonatal lesions

    • Pheochromocytoma
    • Frequency of pheochromocytoma
    • Adrenal haemorrhage in the newborn
    • Neuroblastoma
    • Distribution and age at diagnosis of neuroblastoma

    5 slides

  6. 06

    Surgical anatomy of the adrenal glands

    • Topography and morphology
    • Differences in shape between the two glands
    • Fascial relations and fixation of the gland
    • Separation from and fusion with the kidney
    • Imaging appearance and its limitations
    • Relations of the adrenal glands seen from in front
    • Anatomy of the adrenal glands and their vascular pedicles
    • Structures between the medial borders of the glands
    • Zones of the adrenal gland
    • Combined summary of adrenal embryology, anatomy, physiology and pathology

    10 slides

  7. 07

    Vascular supply, lymphatics and innervation

    • Arterial supply of the adrenal glands
    • Variation in the arterial supply
    • Arterial supply and venous drainage of the adrenal glands
    • Venous drainage of the adrenal glands
    • The right adrenal vein and its surgical rule
    • Variations in adrenal venous drainage
    • Variations in the venous drainage of the adrenal glands
    • Regional divisions of the gland
    • The central adrenal vein within the gland
    • Lymphatic drainage of the adrenal glands
    • Lymphatic drainage of the adrenal glands
    • Innervation of the adrenal glands
    • Nerve supply of the adrenal glands

    13 slides

  8. 08

    Histology and physiology

    • Histology of the adrenal cortex
    • Histology of the adrenal medulla
    • Control of aldosterone secretion
    • Renin, angiotensin and their sites of production and conversion
    • Control of cortisol secretion
    • Feedback relations between adrenal gland, hypothalamus and anterior pituitary
    • Congenital adrenal hyperplasia
    • Enzymatic blocks in adrenal cortisol production
    • Medullary secretion and the sympathoadrenal system
    • Biochemical diagnosis of pheochromocytoma

    10 slides

  9. 09

    Operative approaches to the adrenal glands

    • Indications for adrenal surgery
    • Adrenocortical carcinoma
    • Adrenalectomy during radical nephrectomy
    • The three open approaches
    • Anterior approach: choice of incision
    • Incisions for anterior exposure of the adrenal glands
    • Left adrenal exposure: lateral colonic route
    • Incision of the parietal peritoneum lateral to the left colon
    • Left adrenal exposure: lesser sac route
    • Approach to the left adrenal gland through the gastrocolic omentum
    • Exposing the left gland after pancreatic retraction
    • Left adrenal exposure: transmesocolic route
    • Approach to the adrenal by incision of the left mesocolon
    • Dissection and removal of the left gland
    • The left adrenal gland exposed by upward dissection
    • Bed inspection and splenic injury after left adrenalectomy
    • Right adrenal exposure by the Kocher manoeuvre
    • Right adrenal gland and upper renal pole exposed after the Kocher manoeuvre
    • Control of the right adrenal vein
    • Posterior approach: indications and rationale
    • Posterior approach: incision and rib resection
    • Incisions for the posterior approach to the adrenal glands
    • Posterior approach: exposure of the gland
    • Posterior approach: the right gland
    • Thoracoabdominal approach
    • Incision for the thoracoabdominal approach to the adrenal gland
    • Branches of the phrenic nerves on the cranial surface of the diaphragm

    27 slides

  10. 10

    Laparoscopic adrenalectomy

    • Laparoscopic routes to the adrenal gland
    • Evidence for laparoscopic adrenalectomy
    • Size limits and remaining role of open surgery

    3 slides

  11. 11

    Anatomic complications of adrenalectomy

    • Left anterior approach: vascular injury
    • Renal vessel injury in left adrenalectomy
    • Left anterior approach: organ injury
    • Right anterior approach: vascular injury
    • Right anterior approach: organ injury
    • Posterior approach: vascular injury
    • Posterior approach: organ injury
    • Thoracoabdominal approach: complications
    • Bilateral adrenalectomy in Cushing's syndrome
    • Key anatomical points
    • Key operative points
    • Works cited in the text
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    • Works cited in the text (continued)
    • Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
    • Join our WhatsApp groups

    20 slides