Laparoscopic Adrenal Resection: Changing Techniques for Established Indications.

The operative approach to adrenal cortical tumors must be individualized according to the size and expected nature of the mass. For many years, there have been four distinct surgical approaches from which the surgeon could choose to gain access to the adrenal: anterior/transperitoneal, thoracoabdominal, flank/retroperitoneal, and posterior (Fig 1). The recent development of advanced laparoscopic instruments and techniques, however, has made laparoscopic adrenalectomy the preferred method for resection of most adrenal cortical and medullary tumors.2-12 Each of these diverse operative techniques continues to have a place in the surgical management of these masses. The Table demonstrates how the situation at hand usually plays a dominant role in dictating the appropriate surgical approach. Other factors that may dictate the preferred technique to be used include associated diseases, the overall health of the patient, bilaterality and, of course, the surgeon’s familiarity with each procedure.