ACS Surgery: Principles and Practice

The surgical approach to the adrenals has evolved substantially over the past decade with the development and refinement of techniques for performing laparoscopic adrenalectomy. At present, the majority of adrenal tumors are removed laparoscopically because minimally invasive approaches result in reduced pain, faster recovery, and fewer complications and because the rate of adrenal malignancy is low. Nevertheless, open adrenalectomy still has a role in the management of selected patients with large or malignant tumors. With both open adrenalectomy and laparoscopic adrenalectomy, several different surgical approaches to the adrenals are possible [see Operative Planning, Choice of Procedure, below]. Regardless of the particular approach followed, the keys to successful adrenalectomy are the same: proper patient selection for operation, a solid understanding of adrenal pathophysiology, and a thorough knowledge of adrenal anatomy.