The reasonability of application computed tomography (CT) in differential diagnostics of adrenal tumors and navigation of rational surgical approach for adrenalectomy was specified by possibilities of method development. The special research of CT possibilities in adrenal tumor diagnostics and substantiation of choice of surgical interference were made in 188 patients. An analysis of clinical-laboratory and instrumental data allowed diagnostics of aldosteroma in 26% patients, corticosteroma in 33,0%, chromaffinoma in 24,5%, adrenocortical cancer in 8,5%, hormonally inactive tumor in 8,0%. Results of morphological investigations of removed adrenal tumors were matched with the preoperative CT data. There was revealed a certain density of tumors. On the basis of this density and clinical-laboratory data, the authors could reliably make a diagnosis the disease before the operation, which is very important in asymptomatic illness course and subclinical manifestations.

The possibility of modifying the existing diagnostic algorithm of latent forms of hormone-active and potentially malignant formations in the adrenal glands using modern methods of laboratory diagnostics and radiation imaging is substantiated. In the clinic of a faculty of surgery and on its clinical base, experience in the examination and treatment of 1457 patients with various formations of the adrenal glands has been accumulated. Among them, 270 (14.9%) patients were selected, in whom precursor hormones of steroidogenesis and metabolites of catecholamines in the blood plasma were specially studied by high-performance liquid chromatography, tumor marker measurement, and three-phase computed tomography with intravenous contrast enhancement. Determination of steroidogenesis precursor hormones and catecholamine metabolites in the blood plasma by high-performance liquid chromatography in combination with traditional methods of laboratory diagnostics, use of computed tomography with intravenous contrast enhancement, construction of multiplanar reconstructions, and postprocessor image processing are the basis of a modified algorithm for verification of latent forms of hormone-active and potentially malignant tumors of the adrenal glands. The implementation of the diagnostic algorithm developed in the clinic made early diagnosis of the subclinical forms of NP neoplasms possible, as well as ensure the implementation of minimally invasive surgical interventions before the development of endocrine and metabolic disorders and consequently prevent the development of intraoperative and postoperative complications, which thereby reduce the duration of rehabilitation and disability of patients with good long-term treatment results and high quality of life.

This study evaluated the possibilities of designing a safe access for adrenalectomy using preoperative computed tomography navigation. The outcomes of surgical interventions in 1.457 patients with diseases of the adrenal glands requiring surgery were examined, among which 1.209 patients underwent endovideosurgery with a follow-up period of up to 20 years. Of the total number of patients, 418 were included in the analysis for the preoperative design of access for adrenalectomy using computed tomography navigation. This cohort was conditionally divided into a retrospective group (n = 157) and a prospective group (n = 261). After a comprehensive examination of patients with adrenal formations, according to the algorithm developed at the department, an integral assessment of the leading anthropometric (body mass index and physique form) and computed tomography criteria (i.e., formation diameter; tumor synthopia with respect to the walls of the inferior vena cava; length of the central adrenal vein and the place of its confluence with the lower hollow and renal veins; location of the tumor relative to the lower vein of the right lobe of the liver, as well as relative to the gate of the right kidney; location near the aortorenal vascular triangle; gate of the left kidney; and spleen vessels) allows us to justify the selection of a rational technique and the volume of the surgical treatment. Among endovideosurgical interventions, adrenalectomy from a retroperitoneoscopic access has a significant advantage because it causes the least trauma and short operating time in comparison with laparoscopic access. No intraoperative complications occurred, taking into account the planning of the access option and technique for performing adrenalectomy. Expected complications that may have occurred during adrenalectomy were damage to the central vein of the adrenal glands, renal and spleen vessels, and inferior vena cava and intraoperative blood loss. In general, an increase in operating time directly depends on the peculiarities of the location of the tumor in the adrenal gland, which can be evaluated in detail using preoperative computed tomography, making it possible to reasonably use endovideosurgical or open adrenalectomy alternatives and thus reliably improving the immediate treatment outcomes of the patients.

Aim: to determine the possibilities of modern multislice computed tomography in the preoperative planning of a rational variant of surgical access to the adrenal gland with a tumor. Materials and methods: the results of the examination and treatment of 1196 patients with surgical diseases of the adrenal glands (AG) were studied. The virtual-figurative design of a rational variant of surgical access to AG with a tumor was carried out in 362 patients after evaluating the features of their topographic-anatomical location according to CT-scan. The criterion for the inclusion of patients in the study was the ability to perform after 2013 multislice computed tomography (MSCT) with intravenous contrast on the modern installation Aquillion 64 (Toshiba, Japan) and subsequent post-processing of images with the construction of multiplane and 3D reconstructions. Results: studying the features of the topographic-anatomical location of AGs with a tumor using MSCT allowed us to form a virtual-figurative perception of their syntopy in 362 patients and to design options for access to perform adrenalectomy (AE): retroperitoneoscopic (n = 303), laparoscopic (n = 25), thoracophrenotomy ( n = 30), thoracophrenolaparotomic (n = 5). 363 surgical interventions were performed for 362 patients. A single-sided retroperitoneoscopic AE for pheochromocytoma was performed in 1 patient. Reliable CT criteria were determined that affect the duration and safety of the above-mentioned accesses performed by AEs. It has been established that when designing access to the right AG, it is necessary to consider: the diameter of the neoplasm; the location of the AG with a tumor relative to the inferior vena cava and the lower right hepatic vein; contact with vessels in the gate of the kidney, as well as the presence of additional central veins AG. The determining factors in planning access to the left AG are: neoplasm diameter, contact with vessels in the gate of the kidney and splenic vessels, location in the aorto-renal vascular triangle. It was established that retroperitoneoscopic AE, performed in 83.7% of patients with AG tumors with a diameter of ≤ 8 cm, is an operation of choice. Laparoscopic access remains relevant only when the right-sided localization of an AG tumor with a diameter of up to 8 cm and planning simultaneous surgical interventions on the abdominal organs in individuals of a brachymorphic physique (8.3%). Open approaches are shown in benign lesions of the AG more than 8 cm in diameter, generalized forms of adrenocortical cancer (ACC) (T3-4N0-2M0-1), malignant paragangliomas with signs of invasion or distant metastasis (n = 9.7%). Conclusions: multispiral computed tomography allows, before the operation, to carry out adequate planning of the safest surgical access for adrenalectomy, avoiding the development of intra- and postoperative complications, minimizing operative trauma, shortening the operating time, and speeding up the medical and social rehabilitation of patients.