Has Laparoscopy Impacted the Indications for Adrenalectomy?

Abstract

Laparoscopic adrenalectomy has assumed a greater role in the surgical management of tumors of the adrenal gland. Accompanying this evolution from open to minimally invasive surgery is the inevitable question of whether such change has impacted contemporary indications for adrenalectomy. We explore this question through a review of current laparoscopic adrenalectomy series in the context of established indications for surgical extirpation.

Robot-assisted adrenalectomy: current perspectives

“…Various studies have proved the feasibility, efficacy and safety of this approach. [1][2][3][4] As compared to open adrenalectomy (OA), LA involves lesser blood loss, lesser pain and shorter hospital stay and offers better cosmesis. [5][6][7][8][9][10][11][12] Despite all these advantages, LA has been restricted to a handful of experienced surgeons at high-volume centers because of certain technical drawbacks like two-dimensional view, stiff non-articulating instruments, dependence on an assistant for camera, etc.…”

Nieradykalne (oszczędzające) operacje guzów nadnerczy

“…Additionally, the development of biochemical, genetic, and imaging research allows surgical intervention before any secondary bodily changes (e.g. hormonal preclinical syndromes) have taken place [5]. An additional, though equally important, element influencing the often difficult decision concerning the extent of the tumour resection is the question of substitutive treatment.…”

“…The controversy concerns the assessment and the ruling out of malignant processes, as well as the scope of the removal of normal adrenal tissue in order to safely separate it from the tumour, keeping the removal process radical. This is connected to the pre-surgical assessment of the localisation of the lesion, as well as the differentiation of its nature: whether the tumour is single or multiple, whether it is a case of adenoma, or just a hyperplasia [4,5,6,10].…”

“…Bleeding control in the location of the cut can be achieved by the application of stitches, or by using tools applying varying methods of homeostasis (electrocoagulation, a harmonic knife, a LigaSure, or bicision) [3,5,9,17,18,26,28] (Fig. 9).…”

“…Jednocześnie stwarza warunki na wykonanie resekcji gruczołu nadnerczowego ze świadomym liczeniem się z wystąpieniem wiadomych następstw hormonalnych. Dodatkowo rozwój badań biochemicznych, genetycznych i obrazowych pozwala na ingerencję chirurgiczną przed wytworzeniem wtórnych zmian ustrojowych (hormonalne zespoły przedkliniczne) [5]. Elementem dodatkowym, choć nie mniej ważnym, wpływającym na nierzadko trudną decyzję o zakresie resekcji gruczołu jest kwestia leczenia substytucyjnego.…”