Figure 1.

The following steps of LUS guided left LTA in case of adhesions (white arrows) and changed anatomy. (A) Removal of adhesions; (B) after removal of adhesions the retroperitoneal space is well visible; (C) LUS is used to localize the tumor in the left adrenal gland and its vascularization and define the right plane of dissection; (D,E) the tumor in the left adrenal gland and its vascularization were found with LUS; (F) after precise localization the left adrenal gland with tumor was removed in a safe way without intraoperative complications. LTA, lateral transabdominal adrenalectomy; LAV, left adrenal vein; LRA, left renal artery; LRV, left renal vein; LUS, laparoscopic ultrasound; R, retroperitoneum; S, spleen; T, tumor.