OPPORTUNITIES AND CONTROVERSIES IN ADRENAL SURGERY

Abstract

Introduction. Classical open techniques as well as minimally invasive laparoscopic techniques including robot-assisted are widely used in adrenalectomy. Each case of adrenalectomy requires a meticulous selection of the access route to the adrenal gland, and the final result of the intervention is also largely determined by the approach route that we have chosen.

Materials and methods. Contemporary bibliographic sources were analyzed regarding the particularities and results of different methods of surgical treatment of adrenal gland pathologies. Thus, the following medical databases were consulted: PubMed, HINARI and Google Scholar. The search was performed using the keywords: "adrenalectomy", "laparoscopic adrenal surgery", "adrenal incidentaloma", "pheochromocytoma", "minimally invasive approaches in adrenalectomy", "robot-assisted surgery".

Results. Comparative data between the parameters of surgical interventions performed between different methods of open and minimally invasive interventions, between different approaches to the adrenal glands anterior, lateral or posterior, between different more commonly used minimally invasive approaches – transperitoneal antero-lateral and posterior retroperitoneal, as well as comparative data between minimally invasive laparoscopic and robot-assisted methods were analyzed. Although laparoscopic adrenalectomy has become the preferred intervention in the excision of adrenal gland tumors, the role of open adrenalectomy cannot be underestimated in large tumors (≥6.0cm), as well as suspected malignancy.

Conclusions. Minimally invasive adrenalectomy is appreciated as the preferred approach for all non-cancerous pathologies of the adrenal glands due to the fact that it is associated with less postoperative pain, has a shorter hospitalization, a faster recovery and long-term results similar to those after open surgery.