[Clinico-anatomic rationale for the access and technique in video-endoscopic adrenalectomy]

The results of surgical treatment of 60 patients with tumors of the adrenals with the help of endovideosurgical techniques were analyzed and described. The article also presents the data of experimental investigations performed in 31 corpses of subjects of different constitution and topography of the adrenals in the retroperitoneal space and different accesses to them with the help of endovideosurgical technique. The most effective and safe accesses and the method of endovideosurgical adrenalectomy have been developed, substantiated and approbated in clinical practical work. In most cases the right laparoscopic and left retroperitoneoscopic adrenalectomies should be considered the operations of choice in treatment of patients with tumors of the adrenals. It was proved that the decision for the optimal endovideosurgical access and the corresponding adrenalectomy should be made individually for each patient with special reference to the clinicoanatomical criteria found. The endovideosurgical adrenalectomy should not be opposed to open methods of surgery which are expedient in patients with large size of the tumor, signs of malignancy and possible intraoperative complications.