‘Old Fashioned’ Open Adrenalectomy

Excerpt

Over the last three decades, variations in laparoscopic, retroperitoneoscopic, and now robotic-assisted minimally invasive (MIV) techniques for adrenalectomy have been developed and refined. Current guidelines recommend a MIV approach as the first-line choice for benign adrenal processes of appropriate size. However, performance of open adrenalectomy still accounts for a significant portion of adrenal surgery worldwide [1]. In a study by Lee et al., open adrenalectomy was performed in 46% of patients in a series of 669 patients operated on between 2001 and 2004 [2]. In a separate study of 3100 patients undergoing adrenalectomy, open adrenalectomy was performed in 21% [3]. Currently, an open approach to adrenalectomy is most often selected for large tumors not amenable to MIV resection, tumors suspicious for or known to be adrenocortical carcinoma, some pheochromocytoma/paragangliomas (PPG), those patients with adhesions from prior surgery or other anatomy limiting MIV access, comorbidities limiting utilization of peritoneal or retroperitoneal insufflation and in resource-limited locations without access to MIV equipment or training. …