Challenges of training in adrenal surgery

Gimm, Oliver; Duh, Quan‐Yang

doi:10.21037/gs.2019.01.08

Cited by 12 publications

(5 citation statements)

References 46 publications

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“…It is strongly advisable to use only a 10-mm trocar in order to facilitate the use of different laparoscopic devices (including suction devices, seal and cut devices, and special clamps). More than 5 cm between the ports should be left to allow laparoscopic instruments to move freely [17][18][19].…”

Section: Adrenalectomy -Surgical Techniquementioning

confidence: 99%

“…Some investigations compared the traditional laparoscopic method to single-port adrenalectomy, finding no significant changes in patient length of stay or morbidity, as well as a minor benefit in cosmetic and postoperative discomfort. There is a lack of data on this strategy, and more research is needed [11,17,18,22,23].…”

Section: Single-incision or Single-port Laparoscopic Adrenalectomymentioning

confidence: 99%

“…To prevent recurrence or the development of metastatic illness, which can happen up to 40 years after the tumor was removed, patients with various forms of pheochromocytomas should be monitored for the rest of their lives [17].…”

Section: Postoperative Complications 41 Postoperative Outcomesmentioning

confidence: 99%

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The Surgical Approach in Adrenal Gland Pathology

Mirică¹,

Păun²

2024

Adrenal Glands - The Current Stage and New Perspectives of Diseases and Treatment

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The pathology of the adrenal gland and the clinical management of the adrenal clinical entities are particularly complex. The surgical approach to adrenal disorders, both in the classic way and especially in the minimally invasive way, is reserved for highly addressable centers and experienced surgeons. The surgical treatment is dedicated to both functional and nonfunctional adrenal tumors, closely following specific criteria. Regarding adrenal pathology, the surgical treatment is indicated for adrenal tumors that secret mineralocorticoid hormones (Conn syndrome), adrenal tumors secreting glucocorticoids (Cushing syndrome), pheochromocytomas, paragangliomas, neuroblastomas, adrenal carcinomas, and metastases. At the same time, non-secreting tumors should be removed as soon as imaging details are recorded an increasing dimensions of these tumors during a short time interval (up to one year). Although laparoscopic adrenal removal became a gold standard procedure in the late 90s, the classic open surgical adrenalectomy is reserved for bulky adrenal tumors and adrenal cancers, but it is overshadowed by possible multiple complications such as lung damage, wound infections, thrombosis, bleeding, etc. The minimally invasive approach, either laparoscopically or robotically, is dedicated to small tumors, with the advantage of rapid patient recovery, rapid socio-professional reintegration, and reduction of complications. Laparoscopic adrenalectomy is indicated in a wide range of pathologies, ranging from Conn adenoma, Cushing syndrome, and pheochromocytoma, to hormonal inactive tumors or other pathologies. The surgical sparing of the adrenal cortex is advised in cases of hereditary disorders affecting the adrenal gland (such as the MEN2 syndrome) in order to avoid primary adrenal insufficiency after the surgical excision. The postoperative evolution must be closely monitored by the anesthetic-surgical team, and the subsequent follow-up must not be neglected. We will discuss the primary surgical indications and contraindications of adrenal gland pathology in this chapter, as well as the perioperative management of specific tumors, surgical approach types, pluses and minuses of various adrenal surgery procedures, surgical technique and tactics, potential complications, and postoperative management.

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Section: Adrenalectomy -Surgical Techniquementioning

confidence: 99%

Section: Single-incision or Single-port Laparoscopic Adrenalectomymentioning

confidence: 99%

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The Surgical Approach in Adrenal Gland Pathology

Mirică¹,

Păun²

2024

Adrenal Glands - The Current Stage and New Perspectives of Diseases and Treatment

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“…[10] Especially, most of the adrenal masses detected incidentally are under 4 cm and are non-functional. [12] In patients with benign features in imaging methods, surgery is not required, and clinical and radiological follow-up is recommended. Since the risk of malignancy increases in masses over 4 cm, surgery should be considered individually in these lesions, even if the imaging features are benign.…”

Section: Metastatic Tumorsmentioning

confidence: 99%

“…[7,9] However, some conditions, such as asymptomatic myelolipoma or simple cyst over 4 cm in diameter, may not need surgery. [12]…”

Section: Metastatic Tumorsmentioning

confidence: 99%

Adrenalektomide endikasyonlar ve cerrahi seçenekler

2020

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Bartholomaeus Eustachius in his Opuscula Anatomica as "glandulae renis incumbents" (glands lying on the kidney). In 1805, Cuvier described two anatomical parts of the ad-renals as cortex and medulla without mentioning any functional role of the glands. [1] Its function was understood after it was first described 300 hundred years ago. In 1855, Thomas Addison published his clinicopathologic observa-Indications for adrenalectomy are malignancy suspicion or malignant tumors, non-functional tumors with the risk of malignancy and functional adrenal tumors. Regardless of the size of functional tumors, they have surgical indications. The hormone-secreting adrenal tumors in which adrenalectomy is indicated are as follows: Cushing's syndrome, arises from hypersecretion of glucocorticoids produced in fasciculata adrenal cortex, Conn's syndrome, arises from an hypersecretion of aldosterone produced by glomerulosa adrenal cortex, and Pheochromocytomas that arise from adrenal medulla and produce catecholamines. Sometimes, bilateral adrenalectomy may be required in Cushing's disease due to pituitary or ectopic ACTH secretion. Adenomas arise from the reticularis layer of the adrenal cortex, which rarely releases too much adrenal androgen and estrogen, may also develop and have an indication for adrenalectomy. Adrenal surgery can be performed by laparoscopic or open technique. Today, laparoscopic adrenalectomy is the gold standard treatment in selected patients. Laparoscopic adrenalectomy can be performed transperitoneally or retroperitoneoscopically. Both approaches have their advantages and disadvantages. In the selection of the surgery type, the experience and habits of the surgeon are also important, along with the patient's characteristics. The most common type of surgery performed in the world is laparoscopic transabdominal lateral adrenalectomy, which most surgeons are more familiar with. The laparoscopic anterior transperitoneal approach is the least preferred laparoscopic method in adrenalectomy. Retroperitoneal laparoscopic adrenalectomy can be performed with a posterior or lateral approach. In addition to conventional laparoscopy, laparoscopic surgery is robot-assisted, which can be administered by transperitoneal or retroperitoneal approach. In addition, conventional or robot-assisted laparoscopic adrenalectomy can be performed transabdominally or retroperitoneally using the single-port method. Today, partial adrenalectomy can be performed using laparoscopic techniques in bilateral adrenal masses, hereditary diseases with the risk of developing multiple adrenal tumors, and solitary masses of the adrenal gland. Open surgery is indicated in the case of malignancy or suspected malignancy and large tumors when laparoscopic surgery is contraindicated. The risk of conversion to open surgery is low (approximately 5%). The open transperitoneal anterior approach is the most common open intervention, especially in large tumors with malignancy or suspected malignancy. This procedure can be performed using a midline incision, bi...

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Surgical Procedure: Adrenalectomy – Indications, Operative Techniques and Management of Complications

Bellantone

Crea

2021

Endocrine Surgery Comprehensive Board Exam Guide

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Challenges of training in adrenal surgery

Cited by 12 publications

References 46 publications

The Surgical Approach in Adrenal Gland Pathology

The Surgical Approach in Adrenal Gland Pathology

Adrenalektomide endikasyonlar ve cerrahi seçenekler

Surgical Procedure: Adrenalectomy – Indications, Operative Techniques and Management of Complications

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