Minimally Invasive Adrenal Surgery

Abstract

Since the introduction of minimally invasive surgery, laparoscopic adrenalectomy has become the main treatment option for adrenal masses. Various studies have reported that laparoscopic adrenalectomy showed fewer postoperative complications and faster recovery than conventional open adrenalectomy. Laparoscopic adrenalectomy can be performed through either the transperitoneal approach or the retroperitoneoscopic approach, which are widely used in most adrenal surgical procedures. Furthermore, with the development of minimally invasive surgery, organ-sparing adrenalectomy has recently emerged as a way to conserve functional adrenal gland tissue. According to recent data, organ-sparing adrenalectomy shows promising surgical, functional, and oncological outcomes including less intraoperative blood loss, maintenance of adrenal function, and low recurrence. Partial adrenalectomy was initially proposed for bilateral adrenal tumors in patients with hereditary disease to avoid chronic adrenal insufficiency. However, it has also gained popularity for the treatment of unilateral adrenal disease involving a small adrenal tumor because even patients with a unilateral adrenal gland may develop adrenal insufficiency in stressful situations. Therefore, partial adrenalectomy has become increasingly common to avoid lifelong steroid replacement and recurrence in most cases, especially in bilateral adrenal disease. This review article evaluates the current evidence on minimally invasive adrenalectomy and organ-preserving partial adrenalectomy.

Retroperitoneal laparoscopic partial adrenalectomy (RLPA) for 20-40 mm nonfunctional adrenal tumors in the day surgery mode

“…Laparoscopic adrenalectomy has been reported to be successfully performed in the day surgery or outpatient surgery mode ( 11 , 18 – 20 ). Although partial adrenalectomy is preferable to total adrenalectomy for benign lesions, the potential risk of bleeding should be noted and hemostasis should be ensured during surgery ( 5 ). Nevertheless, a successful implantation of day surgery mode in partial adrenalectomy must be based on the premise of patient safety and surgical outcomes, which largely depend on thorough preoperative assessment and delicate surgical techniques.…”

“…Surgical excision of adrenal tumors ≥ 20 mm has become a consensus among urologists ( 3 ). Retroperitoneal laparoscopic adrenalectomy (RLA) is currently the first-line choice to remove benign adrenal tumors ( 4 , 5 ). However, a growing number of researchers believe that for small (20-40 mm) adrenal tumors, it is preferable to preserve some healthy adrenal tissue in the aim of lowering the risk of postoperative adrenal insufficiency ( 6 , 7 ).…”

Outcome of Partial Adrenalectomy in MEN2 Syndrome: Personal Experience and Systematic Review of Literature

“…These tumors may lead to life-threatening conditions when untreated [ 4 , 5 ]. As PHEOs manifest with bilateral clinical presentation in up to 72% of hereditary and 25% of non-hereditary cases, complete surgical excision, together with systemic blood pressure medications, has been traditionally considered the definitive treatment of the disease [ 6 , 7 , 8 , 9 , 10 ]. Indeed, as a consequence of the (synchronous or metachronous) bilaterality of the disease in the hereditary forms, bilateral total adrenalectomy (TA) is still used in many centers, either as a one step or two-step procedure [ 11 , 12 ].…”

“…Therefore, the selection of patients who will benefit the most from PA, as a component of bilateral surgical treatment, is critical for ensuring good outcomes [ 15 ]. In MEN2-related PHEOs, the specific type of RET mutation is relevant for the planning of surgical strategy: in families with a low incidence of malignancy PA surgery may represent a safe and feasible option to avoid steroid dependency [ 7 , 9 , 10 , 13 , 16 ]. In these patients the importance of preserving normal adrenal tissue is underscored by the risk of decreased quality of life associated with chronic exogenous steroid replacement [ 17 ].…”

Cirugía laparoscópica en incidentaloma suprarrenal para el cirujano general: serie de casos

“…8 La adrenalectomía abierta convencional fue el estándar de oro; sin embargo, después de la introducción de la mínima invasión y la primera adrenalectomía transperitoneal laparoscópica en 1992, con las ventajas de mejor visión, más amplio espacio de trabajo y mejor identificación de la glándula suprarrenal de estructuras adyacentes, es considerado como procedimiento seguro, efectivo y aceptable morbilidad, por lo que en la actualidad es el estándar de oro en casos seleccionados. [9][10][11] El objetivo de este estudio es describir una serie de casos y sus variables en pacientes con incidentaloma suprarrenal resueltos mediante laparoscopía vía transperitoneal por cirugía general en un hospital de segundo nivel.…”