European Surgery

, Volume 44, Issue 3, pp 150–154

Partial adrenalectomy: when, where, and how? Considerations on technical aspect and indications to surgery

  • G. Cavallaro
  • A. Polistena
  • G. D'Ermo
  • C. Letizia
  • G. De Toma


BACKGROUND: Partial (or sub-total) adrenalectomy, first proposed for the treatment of hereditary, bilateral pheochromocytoma in order to preserve adrenocortical function and avoid lifelong steroid replacement therapy, has been adopted more recently in case of sporadic, monolateral tumors, like functioning adenomas or pheochromocytomas, in order to minimize the risk of potential adrenal failure, especially in young patients. METHODS: Based on a literature review and personal experience, the authors critically review this surgical procedure. RESULTS: The authors discuss surgical approach and indication for partial adrenalectomy, and focus on technical aspects and clinico-pathologic results. CONCLUSIONS: Because of the rarity of adrenal tumors and the consequent lack of consistent series, many issues such as correct surgical indications and technical aspects (management of the main adrenal vein, section margins, hemostasis of the adrenal stump, and surgical and functional results) still need to be debated.


Adrenal surgery Laparoscopy Adrenal-sparing surgery Partial adrenalectomy 


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  1. Gagner M, Lacroix A, Bolte E. Laparoscopic adrenalectomy in Cushing's syndrome and pheochromocytoma. N Engl J Med 1992;327:1033–6PubMedCrossRefGoogle Scholar
  2. Irvin GL, Fishman LM, Sher JA. Familial pheochromocytoma. Surgery 1983;94:938–40PubMedGoogle Scholar
  3. Walz MK, Reitgen K, Hoermann R. Posterior retroperitoneoscopy as a new minimally invasive approach for adrenalectomy: results in 37 patients. World J Surg 1996;20:769–74PubMedCrossRefGoogle Scholar
  4. Neumann HPH, Reincke M, Bender BU, Elsner R, Janetschek G. Preserved adrenocortical function after laparoscopic bilateral adrenal sparing surgery for hereditary pheochromocytoma. J Clin Endocrinol Metabol 1999;84:2608–10CrossRefGoogle Scholar
  5. Asari R, Scheuba C, Kaczirek K, Niederle B. Estimated risk of pheochromocytoma recurrence after adrenal-sparing surgery in patients with multiple endocrine neoplasia type 2A. Arch Surg 2006;141:1199–205PubMedCrossRefGoogle Scholar
  6. Janetschek G, Lhotta K, Gasser R, Finkenstedt G, Jaschke W, Bartsch G. Adrenal-sparing laparoscopic surgery for aldosterone-producing adenoma. J Endourol 1997;11:145–8PubMedCrossRefGoogle Scholar
  7. Henniford BT, Ianniti DA, Hale J, Gagner M. The role of intraoperative ultrasonography during laparoscopic adrenalectomy. Surgery 1997;122:1068–73CrossRefGoogle Scholar
  8. Imai T, Tanaka Y, Kikumori T, et al. Laparoscopic partial adrenalectomy. Surg Endosc 1999;13:343–5PubMedCrossRefGoogle Scholar
  9. Kaye DR, Storey BB, Pacak K, Pinto PA, Marston Linehan W, Bratslavsky G. Partial adrenalectomy: underused first line therapy for small adrenal tumors. J Urol 2010;184:18–25PubMedCrossRefGoogle Scholar
  10. Angeli A, Osella G, Ali A, Terzolo M. Adrenal incidentaloma: an overview of clinical and epidemiological data from the National Italian Study Group. Horm Res 1997;47:279–83PubMedCrossRefGoogle Scholar
  11. Kalady MF, McKinlay R, Olson JA Jr, Pinheiro J, Lagoo S, Park A, Eubanks WS. Laparoscopic adrenalectomy for pheochromocytoma. A comparison to aldosteronoma and incidentaloma. Surg Endosc 2004;18:621–5PubMedCrossRefGoogle Scholar
  12. Lev-Chelouche D, Sagie B, Keidar A, Klausern JM, Szold A. Laparoscopic adrenalectomy: indications, technique, xomplications and follow-up. Isr Med Ass J 2003;5:101–4Google Scholar
  13. Ikeda y, Takami H, Niimi M, Saaki y, Takayama J. Laparoscopic partial or cortical sparing adrenalectomy by division of the central adrenal vein. Surg Endosc 2001;15:747–50PubMedCrossRefGoogle Scholar
  14. Janetschek G, Finkenstedt G, Gasser R, Waibel UG, Peschel R, Bartsch G, Neumann HP. Laparoscopic surgery for pheochromocytoma: adrenalectomy, partial resection, excision of paragangliomas. J Urol 1998;160:330–4PubMedCrossRefGoogle Scholar
  15. Neumann HP, Bender BU, Reincke M, Eggstein S, Laubenberger J, Kirste G. Adrenal-sparing surgery for phaeochromocytoma. Br J Surg 1999;81:94–7CrossRefGoogle Scholar
  16. Cheng SP, Saunders BD, Gauger PG, Doherty GM. Laparoscopic partial adrenalectomy for bilateral pheochromocytomas. Ann Surg Oncol 2008;15:2506–8PubMedCrossRefGoogle Scholar
  17. Diner EK, Franks ME, Behari A, Linehan WM, Walther MM. Partial adrenalectomy: the national cancer institute experience. Urology 2005;66:19–23PubMedCrossRefGoogle Scholar
  18. Yip L, Lee LE, Shapiro SE, Waguespack SG, Sherman SI, Hoff AO, Gagel RF, Arens JF, Evans DB. Surgical management of hereditary pheochromocytoma. J Am Coll Surg 2004;198:525–35PubMedCrossRefGoogle Scholar
  19. Nambirajan T, Bagheri F, Abdelmaksoud A, Leeb K, Neumann H, Graubner UB, Janetschek G. Laparoscopic partial adrenalectomy for recurrent pheochromocytoma in a boy with Von Hippel Lindau disease. J Laparoendosc Adv Surg Tech A 2004;14:234–5PubMedGoogle Scholar
  20. Roukounakis N, Dimas S, Kafetzis I, Bethanis S, Gatsulis N, Kostas H, Kyriakou V, Michas S. Is preservation of the adrenal vein mandatory in laparoscopic adrenal-sparing surgery? JSLS 2007;11:215–8PubMedGoogle Scholar
  21. Ihara M, Suzuki R, Kawamata A, Omi Y, Kodama H, Igari Y, Yamazaki K, Obara T. Adrenal-preserving laparoscopic surgery in selected patients with bilateral adrenal tumors. Surgery 2003;134:1066–73CrossRefGoogle Scholar
  22. Van Heerden JA, Sizemore GW, Carney JA, Brennan MD, Sheps SG. Bilateral subtotal adrenal resection for bilateral pheochromocytomas in multiple endocrine neoplasia type IIa: a case report. Surgery 1985;98:363–6PubMedGoogle Scholar
  23. Hamberger B, Telenius-Berg M, Cedermark B, grondal S, Hasson BG, Werner S. Subtotal adrenalectomy in multiple endocrine neoplasia type 2. Henry Ford Hosp Med J 1987;35:127–8PubMedGoogle Scholar
  24. Lee JE, Curley SA, Gagel RF, Evans DB, Hicky RC. Cortical-sparing adrenalectomy for patients with bilateral pheochromocytoma. Surgery 1996;120:1064–71PubMedCrossRefGoogle Scholar
  25. Baghai M, Thompson GB, Young WFJ, Grant CS, Michels VV, van Heerden JA. Pheochromocytoma and paragangliomas in von Hippel-Lindau disease: a role for laparoscopic and cortical-sparing surgery. Arch Surg 2002;137:682–9PubMedCrossRefGoogle Scholar
  26. Assalia A, Gagner M. Laparoscopic adrenalectomy. Br J Surg 2004;91:1259–74PubMedCrossRefGoogle Scholar
  27. Lezoche E, Guerrieri M, Crosta F, Lezoche G, Baldarelli M, Campagnacci R. flank approach versus anterior sub-mesocolic access in left laparoscopic adrenalectomy: a prospective randomized study. Surg Endosc 2008;22:2373–8PubMedCrossRefGoogle Scholar
  28. Lombardi CP, Raffaelli M, De Crea C, Sollazzi L, Perilli V, Cazzato MT, Bellantone R. Endoscopic adrenalectomy: Is there an optimal operative approach? Results of a single-center case-control study. Surgery 2008;144:1008–14PubMedCrossRefGoogle Scholar
  29. Boris RS, Gupta G, Linehan WM, Pinto PA, Bratslavski G. Robot-assisted laparoscopic partial adrenalectomy: initial experience. J Urol 2011;77:775–80CrossRefGoogle Scholar
  30. Yuge K, Miyajima A, Hasegawa M, Miyazaki Y, Maeda T, Takeda T, Takeda A, Miyashita K, Kurihara I, Shibata H, Kikuchi E, Oya M. Initial experience of transumbilical laparoendoscopic single-site surgery of partial adrenalectomy in patient with aldosterone-producing adenoma. BMC Urol 2010;10:19PubMedCrossRefGoogle Scholar
  31. Eisenhofer G, Lenders JW, Linehan WM, Walther MM, Goldstein DS, Keiser HR. Plasma normetanephrine and metanephrine for detecting pheochromocytoma in von hippel-Lindau disease and multiple endocrine neoplasia type 2. N Engl J Med 1999;340:1872–9PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • G. Cavallaro
    • 1
  • A. Polistena
    • 2
  • G. D'Ermo
    • 2
  • C. Letizia
    • 3
  • G. De Toma
    • 2
  1. 1.Department of Medico-Surgical Sciences and Biotechnologies"La Sapienza" University of RomeRomeItaly
  2. 2.Department of Surgery "P. Valdoni", Policlinico Umberto I"La Sapienza" University of RomeRomeItaly
  3. 3.Department of Clinical Sciences, Policlinico Umberto I"La Sapienza" University of RomeRomeItaly

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