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Adrenalectomy techniques

Author
Fiemu Nwariaku, MD, FACS, FWACS
Section Editor
Sally E Carty, MD, FACS
Deputy Editor
Wenliang Chen, MD, PhD

INTRODUCTION

Surgical adrenalectomy is performed for benign (hormonally active or nonfunctional) and malignant tumors. The optimal approach for adrenalectomy continues to evolve as surgeons develop expertise with minimally invasive surgery (both abdominal and retroperitoneal) in different clinical settings. Regardless of surgical approaches, adrenalectomy is a challenging procedure that, in general, should only be performed by surgeons with specialized training. Adrenalectomies performed by high-volume surgeons were associated with fewer complications and lower cost [1].

Various adrenalectomy techniques and their applications are discussed in this topic. The indications, preoperative evaluations, and outcomes are discussed separately in topic reviews of the management of specific adrenal disorders. (See "The adrenal incidentaloma" and "Clinical presentation and evaluation of adrenocortical tumors" and "Treatment of adrenocortical carcinoma" and "Persistent or recurrent Cushing's disease: Surgical adrenalectomy" and "Treatment of pheochromocytoma in adults".)

ANATOMY

The anatomy of the adrenal glands is reviewed separately (figure 1 and figure 2). (See "Surgical anatomy of the adrenal glands".)

SELECTION OF OPERATIVE APPROACH

Adrenalectomy can be performed transabdominally, retroperitoneally, or transthoracically. Transabdominal adrenalectomy is more commonly performed and can be accomplished with either open or minimally invasive surgery (MIS) techniques. Open transabdominal adrenalectomy can be performed via an anterior or thoracoabdominal approach. Open retroperitoneal adrenalectomy is accomplished through a posterior approach. MIS approaches include laparoscopic transabdominal and posterior retroperitoneoscopic (RPA). Thoracoabdominal adrenalectomy is an uncommon procedure and is used in the rare settings of very large tumors usually with diaphragmatic involvement or tumor extension into the chest [2,3].

Principles of resection — The basic surgical principles to minimize intraoperative complications of an adrenalectomy are the same regardless of surgical approach and include:

                                           
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Literature review current through: Sep 2017. | This topic last updated: Jul 26, 2017.
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