title: Surgical strategy in adrenal masses.
abstract: 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.
authors.affiliation: Department of Surgery, Division of General Surgery, University of Vienna Medical School, Währinger Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Prager
authors.forename: Gertraud
authors.initials: G
authors.lastname: Heinz-Peer
authors.forename: Christian
authors.initials: C
authors.lastname: Passler
authors.forename: Klaus
authors.initials: K
authors.lastname: Kaczirek
authors.forename: Martin
authors.initials: M
authors.lastname: Schindl
authors.forename: Christian
authors.initials: C
authors.lastname: Scheuba
authors.forename: Bruno
authors.initials: B
authors.lastname: Niederle
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D006801:Humans