Laparoscopic hand-assisted adrenal-sparing surgery for a giant adrenal myelolipoma: A case report

Adrenal myelolipoma is a rare, benign tumor. Surgical resection is advocated in symptomatic cases, large (size .4 cm) cases, cases where there is an increase in size on follow-up, and cases with an atypical appearance on imaging. Laparoscopic adrenalectomy is currently the gold standard operation for managing benign adrenal mass. However, to date, laparoscopic entire resection of ipsilateral adrenal gland with the tumor has mainly been reported in the literature. Under clinical circumstances, adrenal-sparing surgery is underused as first-line therapy for adrenal tumors. We present a case of adrenal myelolipoma involving the right adrenal gland of a 45-year-old woman who presented with right-sided flank pain. On radiologic and endocrine evaluation, she received a diagnosis of a giant adrenal myelolipoma (.8 cm). Right hand-assisted laparoscopic partial adrenalectomy was performed, and postoperative recovery was uneventful. Finally, histologic examination confirmed adrenal myelolipoma. On followup computed tomography, there was no residual tumor and the remaining right adrenal gland. Our report suggests that hand-assisted laparoscopic partial adrenalectomy could be considered for appropriate removal of adrenal myelolipoma, even in giant adrenal myelolipoma.