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Surgical strategy in adrenal masses. |
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| Authors: | Gerhard Prager Gertraud Heinz-Peer Christian Passler Klaus Kaczirek Martin Schindl Christian Scheuba Bruno Niederle |
| Affiliation: | 1. Department of Surgery, Division of General Surgery, Section of Endocrine Surgery, University of Vienna, Medical School, Währinger Guertel 18-20, A-1090 Vienna, Austria;2. Department of Radiology, Division of Surgical Radiology, University of Vienna, Medical School, Vienna, Austria;1. Department of Surgical Oncology, Sindi Ahluwalia Hawkins Centre for the Southern Interior, BC Cancer Agency, Kelowna, BC, Canada;2. Southern Medical Program, University of British Columbia Okanagan, Kelowna, BC, Canada;3. Cancer Surveillance and Outcomes, BC Cancer Agency, Vancouver, BC, Canada;4. Department of Surgery, University of British Columbia, Vancouver, BC, Canada;5. Department of Surgery, Kelowna General Hospital, Kelowna, BC, Canada;1. Division of Pediatric Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA;2. Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA;1. Department of Surgery, University of Washington, Seattle, Washington;2. Surgical Outcomes Research Center, University of Washington, Seattle, Washington;1. Department of Surgery, Duke University Medical Center, Durham, NC;2. Department of Anesthesiology, Duke University Medical Center, Durham, NC |
| Abstract: | OBJECTIVE: Endoscopic adrenalectomy represents the "New Golden Standard" in the surgical treatment of benign adrenal lesions up to 6 cm. Open adrenalectomy is recommended for patients with suspected malignant disease and tumors larger than 6 cm. METHODS AND MATERIAL: The surgical technique of trans- and retroperitoneal adrenalectomy is described. Reviewing literature the importance of the endoscopic approach and its role in the surgical treatment of adrenal lesions is analyzed. RESULTS: As in open adrenalectomy different endoscopic approaches to the adrenals were developed: adrenal tumors can be removed endoscopically using a transperitoneal (patient in a supine or lateral decubitus position) or extraperitoneal route (patient in a lateral decubitus or prone position). Reviewing literature the endoscopic transperitoneal adrenalectomy is documented in 1425 patients. 4.6% (66 patients) had to be converted to an open procedure. Five hundred and forty-four tumors were removed by an extraperitoneal access. The conversion rate was 4.4% (24 patients). CONCLUSION: The basis of excellent results are careful patient selection, evaluation and preoperative preparation in a center with experience in the open techniques and at least 20 endoscopic adrenalectomies per year. |
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