Valutazione delle vie di accesso tradizionali nella surrenalectomia

The choice of operative approach represents one of the main problems of adrenal gland surgery, nowadays the minimally invasive techniques (laparoscopic adrenalectomy) in selected cases may be an important alternative to conventional approaches. Retrospective analysis was performed on 140 patients with adrenal gland tumors from 1980-1997; there were 95 women and 45 men: The tumors were resected through flank extraperitoneal approach (35 patients), transabdominal (91), thoraco-abdominal (14). Operating time, perioperative blood loss, postoperative course were evaluated. The authors conclude that in functioning and non-functioning adenomas, in pheochromocytoma, smaller than 6 cm., with precise pre-operative unilateral localization, flank extraperitoneal approach may be sufficient, in patients with Cushing disease resistant to pituitary surgery or irradiation, in patients with familiar history or bilateral pheochromocytoma, in patients with suspected malignant disease, a thorough surgical exploration of the abdominal cavity is recommended.