Laparoscopic adrenalectomy

Advances in biochemistry, molecular genetics, and imaging have led to earlier and more accurate diagnosis of adrenal pathology. Rapid development and dissemination of new surgical instruments and techniques have lowered the morbidity and mortality from adrenal operations. Laparoscopic adrenalectomy (LA) has become a gold standard in the treatment of most adrenal disorders. The popularity of laparoscopic approach for adrenalectomy is mainly due to the magnification and better dissection of this deeply situated gland. Knowledge of the anatomy of the adrenal gland and meticulous hemostasis, are key to success in laparoscopic approach. By applying defined selection criteria for the treatment of adrenal lesions, LA can be a safe procedure and may be performed in at least two thirds of patients. Large and/or irregular adrenal tumors have a high risk of malignancy and require radical en bloc resection to avoid local recurrence. It is therefore important to investigate tumors carefully by preoperative imaging and it would appear, that in most cases, primary adrenal malignancies are best approached in an open fashion unless the tumor is small and well circumscribed and the surgeon is highly experienced. The choice of endoscopic or open approach in these adrenal tumors should depend on the results of preoperative imaging studies and the endocrine surgeon’s experience in endoscopic adrenal surgery. The success or failure of laparoscopic adrenalectomy depends on.