Surgical strategy in adrenal masses.
OBJECTIVE
Endoscopic adrenalectomy represents the "New Golden Standard" in the surgical treatment of benign adrenal lesions up to 6 cm. Open adrenalectomy is recommended for patients with suspected malignant disease and tumors larger than 6 cm.


METHODS
The surgical technique of trans- and retroperitoneal adrenalectomy is described. Reviewing literature the importance of the endoscopic approach and its role in the surgical treatment of adrenal lesions is analyzed.


RESULTS
As in open adrenalectomy different endoscopic approaches to the adrenals were developed: adrenal tumors can be removed endoscopically using a transperitoneal (patient in a supine or lateral decubitus position) or extraperitoneal route (patient in a lateral decubitus or prone position). Reviewing literature the endoscopic transperitoneal adrenalectomy is documented in 1425 patients. 4.6% (66 patients) had to be converted to an open procedure. Five hundred and forty-four tumors were removed by an extraperitoneal access. The conversion rate was 4.4% (24 patients).


CONCLUSIONS
The basis of excellent results are careful patient selection, evaluation and preoperative preparation in a center with experience in the open techniques and at least 20 endoscopic adrenalectomies per year.
Prager
Gerhard
G
Department of Surgery, Division of General Surgery, University of Vienna Medical School, Währinger Guertel 18-20, A-1090 Vienna, Austria.
Heinz-Peer
Gertraud
G
Passler
Christian
C
Kaczirek
Klaus
K
Schindl
Martin
M
Scheuba
Christian
C
Niederle
Bruno
B
D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D006801:Humans