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Indications for adrenalectomy are malignancy suspicion or malignant tumors, non-functional tumors with the risk of malignancy and functional adrenal tumors. Regardless of the size of functional tumors, they have surgical indications. The hormone-secreting adrenal tumors in which adrenalectomy is indicated are as follows: Cushing’s syndrome, arises from hypersecretion of glucocorticoids produced in fasciculata adrenal cortex, Conn’s syndrome, arises from an hypersecretion of aldosterone produced by glomerulosa adrenal cortex, and Pheochromocytomas that arise from adrenal medulla and produce catecholamines. Sometimes, bilateral adrenalectomy may be required in Cushing's disease due to pituitary or ectopic ACTH secretion. Adenomas arise from the reticularis layer of the adrenal cortex, which rarely releases too much adrenal androgen and estrogen, may also develop and have an indication for adrenalectomy. Adrenal surgery can be performed by laparoscopic or open technique. Today, laparoscopic adrenalectomy is the gold standard treatment in selected patients. Laparoscopic adrenalectomy can be performed transperitoneally or retroperitoneoscopically. Both approaches have their advantages and disadvantages. In the selection of the surgery type, the experience and habits of the surgeon are also important, along with the patient’s characteristics. The most common type of surgery performed in the world is laparoscopic transabdominal lateral adrenalectomy, which most surgeons are more familiar with. The laparoscopic anterior transperitoneal approach is the least preferred laparoscopic method in adrenalectomy. Retroperitoneal laparoscopic adrenalectomy can be performed with a posterior or lateral approach. In addition to conventional laparoscopy, laparoscopic surgery is robot-assisted, which can be administered by transperitoneal or retroperitoneal approach. In addition, conventional or robot-assisted laparoscopic adrenalectomy can be performed transabdominally or retroperitoneally using the single-port method. Today, partial adrenalectomy can be performed using laparoscopic techniques in bilateral adrenal masses, hereditary diseases with the risk of developing multiple adrenal tumors, and solitary masses of the adrenal gland. Open surgery is indicated in the case of malignancy or suspected malignancy and large tumors when laparoscopic surgery is contraindicated. The risk of conversion to open surgery is low (approximately 5%). The open transperitoneal anterior approach is the most common open intervention, especially in large tumors with malignancy or suspected malignancy. This procedure can be performed using a midline incision, bilateral or unilateral subcostal incision, Makuuchi or modified Makuuchi incision. Thoracoabdominal incision may be required, especially in the removal of large malignant lesions as a block. The open retroperitoneal approach can be applied posteriorly or laterally.
Indications for adrenalectomy are malignant or malignant tumors, non-functional tumors with malignant risk and functional adrenal tumors. Regardless of the size of functional tumors, they have surgical indications. The tumors that are caused by the functional adrenal cortex; the adenomas that are caused by the fasiculate layer in Cushing syndrome and produce excess glucocorticoids, the adenomas that are caused by excess aldesterone, caused by the glomerulosis layer in Conn syndrome, and the adenomas that are caused by excess catecolamine caused by the adrenal medula, the feochromocytoma has an adrenalectomy indication that causes excess catecolamine. Sometimes it may be necessary to apply bilateral adrenalectomy to Cushing's disease associated with hypofyser or ectopic ACTH discharge. Rarely, adenomas caused by the reticular layer of the adrenal cortex that emits too much adrenal androgens and estrogen can also develop, and they also have an indication of adrenalectomy. Adrenal surgery can be applied with laparascopic or open technique. Today, laparoscopic adrenalectomy in selected patients is the golden standard treatment. Laparoscopic adrenalectomy can be applied transperitoneal or retroperitoneoscopic. Both approaches have each other’s advantages and disadvantages. In the choice of the type of surgery, the experience and habits of the surgeon, along with the characteristics of the patient, are also important. The most common type of surgery in the world is laparoscopic transabdominal lateral adrenalectomy, which most surgeons are also more familiar with. Laparoscopic anterior transperitoneal approach is the least preferred laparoscopic method in adrenalectomy. Retroperitoneal laparoscopic adrenalectomy can be applied with a posterior or lateral approach. Laparascopic surgery, along with conventional laparoscopy, can be applied by a robot; transperitoneal or retroperitoneal. Also, conventional or robotic laparoscopic adrenalectomy can also be applied transabdominal or retroperitoneal by single port method. Today, in bilateral adrenal masses, hereditary diseases that are at risk of developing multiple adrenal tumors, in adrenal solitary masses, partial adrenalectomy can be applied especially with laparoscopic techniques. In suspicion of malignity or malignity, in large tumors, there is a clear surgical indication when laparoscopic surgery is contraindicated. The risk of laparoscopic surgery is approximately 5%. Open transperitoneal anterior approach is the most commonly applied open attempt in major tumors with malignity or malignity. This initiative can be applied with middle-line injection, bilateral or unilateral subcostal injection, Makuuchi or modified Makuuchi injection. It may be necessary to do torakoabdominal injection, especially when large malignant lesions are removed as a block. Open retroperitoneal approach can be applied laterally or laterally. (SETB-2019-12-157)
Field : Sağlık Bilimleri
Journal Type : Ulusal
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