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.

Keywords: Adrenal gland neoplasms; Adrenalectomy; Laparoscopy; Organ preservation.

Fig. 1

(A) Position for left lateral transperitoneal adrenalectomy. (B) Position for posterior retroperitoneoscopic adrenalectomy. (C) Intraoperative view of left lateral transperitoneal adrenalectomy. (D) Intraoperative view of left posterior retroperitoneoscopic adrenalectomy. (E) Intraoperative view of right lateral transperitoneal adrenalectomy. (F) Intraoperative view of right posterior retroperitoneoscopic adrenalectomy. Adapted from Chai et al. [5]. IVC, inferior vena cava.

Fig. 2

(A) Exposure of left adrenal gland for partial adrenalectomy. (B) Left partial adrenalectomy preserving normal residual adrenal tissue. IVC, inferior vena cava.