SURGERY OF THE ADRENAL GLANDS

SURGERY OF THE ADRENAL GLANDS

Since its description in the 1990s by Gagner, laparoscopic adre - nalectomy has become the gold standard in the resection of adrenal tumours, except for tumours with signs of malignancy . Since then, the retroperitoneoscopic modification of the poste - rior open approac h described by Walz has gained popularity . The transperitoneal laparoscopic approach o ff ers a better view of the adrenal region than open surgery and, because the anatomy is more familiar, it is more commonly employ ed. However, the retroperitoneoscopic approach requires less dissection because it is extraperitoneal; it is most advantageous in patients with small and/or bilateral tumours, e.g. inherited disease. For adrenal surgery as a whole, the mortality rate is less than 0.5% but is higher in the setting of malignant adrenal tumours. The open anterior approach should be undertaken if there are radiological signs of invasion, limited metastases, suggest malignancy . To avoid steroid dependence, subtotal adrenalectomy is an option in patients with bilateral tumours provided they are small (<3 /uni00A0 cm). It is important to emphasise that these excellent outcomes depend on an experienced surgical team and close liaison with endocrinology colleagues to ensure that any hormonal excess is identified preoperatively , controlled to render surgery safe then supplemented if needed in the postoperative period.