OPEN SURGICAL APPROACHES IN ADRENALECTOMY: TECHNICAL VARIANTS AND CURRENT ANATOMICAL CONSIDERATIONS

Abstract

Background. Adrenal surgery has progressed considerably since its introduction in the late 19th century, when the first adrenalectomies were performed. Over time, several open surgical approaches have been developed. The anterior (transabdominal) approach is generally preferred by general and abdominal surgeons, while the posterior (retroperitoneal) approach is more frequently used by urologists. The final outcome of adrenalectomy depends on multiple factors, with the surgical technique being a decisive one.

Objectives. To review and compare the main open surgical approaches used in adrenalectomy, focusing on their technical features, anatomical considerations, and specific indications for each method.

Materials and Methods. A comprehensive literature review was conducted using international medical databases (PubMed, HINARI, and Google Scholar). The keywords used were: suprarenalectomy, open adrenalectomy, laparoscopic adrenal surgery, adrenal incidentaloma, pheochromocytoma, minimally invasive adrenal approaches, and robot-assisted surgery. A total of 42 relevant studies prospective and retrospective, single- and multicenter published between 2000 and 2024, were included in the analysis.

Results. Three main open surgical approaches — anterior, lateral, and posterior — were analyzed in detail. Access to the adrenal gland can be achieved through transperitoneal or retroperitoneal routes. The transabdominal approach provides wide visualization of the retroperitoneal and paranephric spaces, allowing precise control of the renal pedicle and major vessels, which is crucial in large or malignant tumors. Conversely, the lumbodorsal approach, though shorter and less traumatic, offers a limited working space and is reserved for small bilateral or hormonally active lesions.

Conclusions. Open surgical approaches for adrenal gland diseases remain varied and are selected based on the surgeon’s experience and the patient’s specific clinical profile. The transabdominal technique ensures optimal exposure of major retroperitoneal structures and remains the preferred method for large or malignant adrenal tumors.