Adrenalectomy: expanded indications for the extraperitoneal approach.
The adrenal glands can be removed surgically by the anterior transperitoneal approach, or by the extraperitoneal approaches, either posteriorly or posterolaterally. While the extraperitoneal routes have become accepted as the preferred approach to the adrenal glands for small benign cortical adenomas, many authors still recommend the anterior transperitoneal route as the preferred operative approach for phaeochromocytoma, large tumours, adrenal cancers or bilateral hyperplasia. A series of 51 consecutive adrenalectomies performed for a wide range of adrenal disorders is presented, including phaeochromocytoma and large malignant tumours. In 47 cases the tumours were successfully removed through an extraperitoneal approach, with minimal morbidity. The anterior approach had to be employed in only four cases, and in three of these there was pre-operative evidence of tumour invasion into either the major vessels or the liver. The extraperitoneal approach to the adrenal gland is technically simple and can be performed quickly, with a low postoperative morbidity and should be regarded as the routine approach for almost all adrenal procedures.
Endocrine Surgical Unit, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
T J
TJ
Fahey
T S
TS
Reeve
L
L
Delbridge
D000306:Adrenal Cortex Neoplasms / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D003480:Cushing Syndrome / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000601:surgery; D012189:Retrospective Studies