ABSTRACT
The key to successful adrenalectomy remains proper patient selection, a good understanding of adrenal pathophysiology, and a thorough knowledge of adrenal anatomy.
Over the last two decades, many minimally invasive techniques have been introduced including the laparoscopic, posterior retroperitoneoscopic, and robotic approaches.
Laparoscopic lateral transabdominal adrenalectomy is the most popular procedure as it allows for wide exposure of the retroperitoneal space and takes advantage of mobilization of organs due to gravity in both left and right lateral positions: spleen, pancreas, or liver. Open adrenalectomy consists of transabdominal or retroperitoneal approaches that have now been largely adapted to minimally invasive surgery for adrenal resection, except in large tumors and malignant disease.
Posterior retroperitoneoscopic adrenalectomy (PRA) is a newer procedure, advantageous mainly due to easy access to the posterior location of the adrenal glands in the retroperitoneum. PRA directly approaches this space, enabling adrenalectomy without the need to dissect away intra-abdominal organs. Furthermore, PRA is feasible in patients with a previous history of abdominal surgery, as well as being suitable for bilateral adrenalectomy. Recent reports of good intra- and postoperative outcomes of PRA have made this method more popular.
Minimally invasive approaches are favored in the surgical treatment of adrenal tumors and are the standard of care at many specialized medical centers worldwide. The choice of laparoscopic transabdominal or retroperitoneal adrenalectomy is strongly influenced by surgeon factors. In the future, robotic adrenalectomy will likely assume an increased role in the management of surgical disease.
