Surgical Indications and Techniques for Adrenalectomy.

Area of Science:

• Endocrinology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Adrenalectomy is a surgical procedure to remove one or both adrenal glands.
• Indications include suspected malignancy, malignant tumors, non-functional tumors with malignancy risk, and functional adrenal tumors causing conditions like Cushing's syndrome, Conn's syndrome, and pheochromocytomas.

Purpose of the Study:

• To review the indications for adrenalectomy.
• To discuss the surgical techniques, including laparoscopic and open approaches.
• To highlight the current gold standard and emerging techniques in adrenal surgery.

Main Methods:

• Review of indications for adrenalectomy based on tumor characteristics and hormonal activity.
• Comparison of laparoscopic (transperitoneal, retroperitoneal, robot-assisted, single-port) and open surgical approaches.
• Discussion of surgical decision-making factors, including surgeon experience and patient characteristics.

Main Results:

• Laparoscopic adrenalectomy is the gold standard for selected patients, with transabdominal lateral being most common.
• Open surgery is reserved for malignancy suspicion or contraindications to laparoscopy, with a low conversion rate (approx. 5%).
• Partial adrenalectomy is feasible with laparoscopic techniques for specific bilateral or hereditary conditions.

Conclusions:

• Adrenalectomy indications encompass a range of neoplastic and functional adrenal conditions.
• Laparoscopic adrenalectomy offers advantages and is the preferred approach in most cases.
• Surgical technique selection depends on tumor specifics, patient factors, and surgeon expertise.