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Surgical Procedure: Adrenalectomy – Indications, Operative Techniques and Management of Complications

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Endocrine Surgery Comprehensive Board Exam Guide

Abstract

The aim of this chapter is to provide an overview of the principal route of access to adrenal gland available in the contemporary surgical armamentarium, detailing the surgical technique of each of them. The feasibility and the role of minimally invasive adrenalectomy (laparoscopic and robotic approaches) are specifically addressed with evidence from most recent peer-reviewed literature. The advantages and the disadvantages of each technique are considered and related to the specific indication for adrenalectomy. Additionally, trips and tracks distinctive of each technique as well as the main complications are discussed. Subject-oriented clinical cases and multiple-choice questions are added.

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References

  1. Young WF Jr. Clinical practice. The incidentally discovered adrenal mass. N Engl J Med. 2007;356(6):601–10.

    Article  PubMed  CAS  Google Scholar 

  2. Davenport C, Liew A, Doherty B, Win HHN, Misran H, Hanna S, Kealy D, Al-Nooh F, Agha A, Thompson CJ, Lee M, Smith D. The prevalence of adrenal incidentaloma in routine clinical practice. Endocrine. 2011;40:80–3.

    Article  PubMed  CAS  Google Scholar 

  3. Gimm O, Duh QY. Challenges of training in adrenal surgery. Gland Surg. 2019;8(Suppl 1):S3–9.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Mihai R, Donatini G, Vidal O, Brunaud L. Volume-outcome correlation in adrenal surgery-an ESES consensus statement. Langenbeck’s Arch Surg. 2019;404:795–806.

    Article  Google Scholar 

  5. NIH state-of-the-science statement on management of the clinically inapparent adrenal mass (“incidentaloma”). NIH Consens State Sci Statements. 2002;19(2):1–25.

    Google Scholar 

  6. Fassnacht M, Arlt W, Bancos I, Dralle H, Newell-Price J, Sahdev A, Tabarin A, Terzolo M, Tsagarakis S, Dekkers OM. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2016;175:G1–34.

    Article  PubMed  CAS  Google Scholar 

  7. Thornton JK. Abdominal nephrectomy for large sarcoma of the left suprarenal capsule: recovery. Trans Clin Soc Lond. 1890;23:150.

    Google Scholar 

  8. Mayo CH. Paroxysmal hypertension with tumor of retroperitoneal nerve. JAMA. 1927;89:1047.

    Article  Google Scholar 

  9. Young HH. A technique for simultaneous exposure and operation on the adrenals. Surgery. 1936;63:179.

    Google Scholar 

  10. Smith CD, Weber CJ, Amerson JR. Laparoscopic adrenalectomy: new gold standard. World J Surg. 1999;23:389–96.

    Article  PubMed  CAS  Google Scholar 

  11. 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(6):1008–14.

    Article  PubMed  Google Scholar 

  12. Henry JF, Sebag F, Iacobone M, Mirallie E. Results of laparoscopic adrenalectomy for large and potentially malignant tumors. World J Surg. 2002;26(8):1043–7.

    Article  PubMed  Google Scholar 

  13. Lombardi CP, Raffaelli M, De Crea C, Bellantone R. Role of laparoscopy in the management of adrenal malignancies. J Surg Oncol. 2006;94:128–31.

    Article  PubMed  Google Scholar 

  14. Bellantone R, Lombardi CP, Raffaelli M. What is the appropriate role of minimally invasive vs. open surgery for small adrenocortical cancers? Curr Opin Oncol. 2015 Jan;27(1):44–9.

    Article  PubMed  Google Scholar 

  15. Gaujoux S, Mihai R. Joint working group of ESES and ENSAT. European Society of Endocrine Surgeons (ESES) and European Network for the Study of Adrenal Tumours (ENSAT) recommendations for the surgical management of adrenocortical carcinoma. Br J Surg. 2017;104(4):358–76.

    Article  PubMed  CAS  Google Scholar 

  16. Miller BS, Ammori JB, Gauger PG, Broome JT, Hammer GD, Doherty GM. Laparoscopic resection is inappropriate in patients with known or suspected adrenocortical carcinoma. World J Surg. 2010;34:1380–5.

    Article  PubMed  CAS  Google Scholar 

  17. Gaujoux S, Bonnet S, Leconte M, Zohar S, Bertherat J, Bertagna X, Dousset B. Risk factors for conversion and complications after unilateral laparoscopic adrenalectomy. Br J Surg. 2011;98(10):1392–9.

    Article  PubMed  CAS  Google Scholar 

  18. Raffaelli M, De Crea C, Bellantone R. Laparoscopic adrenalectomy. Gland Surg. 2019;8(Suppl 1):S41–52.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gagner M, Lacroix A, Boltè E. Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med. 1992;327:1033.

    Article  PubMed  CAS  Google Scholar 

  20. Gagner M, Lacroix A, Bolte E, Pomp A. Laparoscopic adrenalectomy. The importance of a flank approach in the lateral decubitus position. Surg Endos. 1994;8:135–8.

    Article  CAS  Google Scholar 

  21. Marescaux J, Mutter D, Wheeler MH. Laparoscopic right and left adrenalectomies. Surgical procedures. Surg Endosc. 1996;10(9):912–5.

    Article  PubMed  CAS  Google Scholar 

  22. Assalia A, Gagner M. Laparoscopic adrenalectomy. Br J Surg. 2004;91(10):1259–74.

    Article  PubMed  CAS  Google Scholar 

  23. Henry JF. Minimally invasive adrenal surgery. Best Pract Res Clin Endocrinol Metab. 2001;15(2):149–60.

    Article  PubMed  CAS  Google Scholar 

  24. Prinz RA. A comparison of laparoscopic and open adrenalectomies. Arch Surg. 1995;130:489–92.

    Article  PubMed  CAS  Google Scholar 

  25. Brunt LM, Doherty GM, Norton JA, Soper NJ, Quasebarth MA, Moley JF. Laparoscopic adrenalectomy compared to open adrenalectomy for benign adrenal neoplasms. J Am Coll Surg. 2001;183:1–10.

    Google Scholar 

  26. Thompson GB, Grant CS, van Heerden JA, Schlinkert RT, Young WF Jr, Farley DR, Ilstrup DM. Laparoscopic versus open posterior adrenalectomy: a case-control study of 100 patients. Surgery. 1997;122:1132–6.

    Article  PubMed  CAS  Google Scholar 

  27. Dudley NE, Harrison BJ. Comparison of open posterior versus transperitoneal laparoscopic adrenalectomy. Br J Surg. 1999;86:656–60.

    Article  PubMed  CAS  Google Scholar 

  28. Imai T, Kikumori T, Ohiwa M, Mase T, Funahashi H. A case-controlled study of laparoscopic compared with open lateral adrenalectomy. Am J Surg. 1999;178:50–3.

    Article  PubMed  CAS  Google Scholar 

  29. Lee J, El-Tamer M, Schifftner T, Turrentine FE, Henderson WG, Khuri S, Hanks JB, Inabnet WB 3rd. Open and laparoscopic adrenalectomy: analysis of the National Surgical Quality Improvement Program. J Am Coll Surg. 2008;206(5):953–9.

    Article  PubMed  Google Scholar 

  30. Elfenbein DM, Scarborough JE, Speicher PJ, Scheri RP. Comparison of laparoscopic versus open adrenalectomy: results from American College of Surgeons-National Surgery Quality Improvement Project. J Surg Res. 2013;184(1):216–20.

    Article  PubMed  Google Scholar 

  31. Eichhorn-Wharry LI, Talpos GB, Rubinfeld I. Laparoscopic versus open adrenalectomy: another look at outcome using the Clavien classification system. Surgery. 2012;152(6):1090–5.

    Article  PubMed  Google Scholar 

  32. Miller BS, Doherty GM. Surgical management of adrenocortical tumours. Nat Rev Endocrinol. 2014;10:282–92.

    Article  PubMed  Google Scholar 

  33. Schteingart DE, Doherty GM, Gauger PG, Giordano TJ, Hammer GD, Korobkin M, Worden FP. Management of patients with adrenal cancer: recommendations of an international consensus conference. Endocr Relat Cancer. 2005;12(3):667–80.

    Article  PubMed  CAS  Google Scholar 

  34. Gonzalez RJ, Shapiro S, Sarlis N, Vassilopoulou-Sellin R, Perrier ND, Evans DB, Lee JE. Laparoscopic resection of adrenal cortical carcinoma: a cautionary note. Surgery. 2005;138:1078–85.

    Article  PubMed  Google Scholar 

  35. Carnaille B. Adrenocortical carcinoma: which surgical approach? Langenbeck’s Arch Surg. 2012;397:195–9.

    Article  Google Scholar 

  36. MacGillivray DC, Whalen GF, Malchoff CD, Oppenheim DS, Shichmann SJ. Laparoscopic resection of large adrenal tumors. Ann Surg Oncol. 2002;9(5):480–5.

    Article  PubMed  Google Scholar 

  37. Fassnacht M, Kroiss M, Allolio B. Update in adrenocortical carcinoma. J Clin Endocrinol Metab. 2013;98:4551–64.

    Article  PubMed  CAS  Google Scholar 

  38. Else T, Kim AC, Sabolch A, Raymond VM, Kandathil A, Caoili EM, Jolly S, Miller BS, Giordano TJ, Hammer GD. Adrenocortical carcinoma. Endocr Rev. 2014;35:282–326.

    Article  PubMed  CAS  Google Scholar 

  39. Ronchi CL, Kroiss M, Sbiera S, Deutschbein T, Fassnacht M. Current and evolving treatment options in adrenocortical carcinoma: where do we stand and where do we want to go? Eur J Endocrinol. 2014;171:R1–R11.

    Article  PubMed  CAS  Google Scholar 

  40. Fassnacht M, Dekkers O, Else T, Baudin E, Berruti A, de Krijger R, Haak H, Mihai R, Assie G, Terzolo M. European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2018;179(4):G1–G46.

    Article  PubMed  CAS  Google Scholar 

  41. Miccoli P, Raffaelli M, Berti P, Materazzi G, Massi M, Bernini G. Adrenal surgery before and after the introduction of laparoscopic adrenalectomy. Br J Surg. 2002;89:779–82.

    Article  PubMed  CAS  Google Scholar 

  42. O’Neill CJ, Spence A, Logan B, Suliburk JW, Soon PS, Learoyd DL, Sidhu SB, Sywak MS. Adrenal incidentalomas: risk of adrenocortical carcinoma and clinical outcomes. J Surg Oncol. 2010;102:450–3.

    Article  PubMed  Google Scholar 

  43. Fassnacht M, Johanssen S, Quinkler M, Bucsky P, Willenberg HS, Beuschlein F, Terzolo M, Mueller HH, Hahner S, Allolio B, German Adrenocortical Carcinoma Registry Group; European Network for the Study of Adrenal Tumors. Limited prognostic value of the 2004 international union against cancer staging classification for adrenocortical carcinoma: proposal for a Revised TNM classification. Cancer. 2009;115:243–50.

    Article  PubMed  Google Scholar 

  44. Grubbs EG, Callender GG, Xing Y, Perrier ND, Evans DB, Phan AT, Lee JE. Recurrence of adrenal cortical carcinoma following resection: surgery alone can achieve results equal to surgery plus mitotane. Ann Surg Oncol. 2010;17:263–70.

    Article  PubMed  Google Scholar 

  45. Leboulleux S, Deandreis D, Al Ghuzlan A, Aupérin A, Goéré D, Dromain C, Elias D, Caillou B, Travagli JP, De Baere T, Lumbroso J, Young J, Schlumberger M, Baudin E. Adrenocortical carcinoma: is the surgical approach a risk factor of peritoneal carcinomatosis? Eur J Endocrinol. 2010;162:1147–53.

    Article  PubMed  CAS  Google Scholar 

  46. Porpiglia F, Fiori C, Daffara F, Zaggia B, Bollito E, Volante M, Berruti A, Terzolo M. Retrospective evaluation of the outcome of open versus laparoscopic adrenalectomy for stage I and II adrenocortical cancer. Eur Urol. 2010;57:873–8.

    Article  PubMed  Google Scholar 

  47. Brix D, Allolio B, Fenske W, Agha A, Dralle H, Jurowich C, Langer P, Mussack T, Nies C, Riedmiller H, Spahn M, Weismann D, Hahner S, Fassnacht M, German Adrenocortical Carcinoma Registry Group. Laparoscopic versus open adrenalectomy for adrenocortical carcinoma: surgical and oncologic outcome in 152 patients. Eur Urol. 2010;58:609–15.

    Article  PubMed  Google Scholar 

  48. Miller BS, Gauger PG, Hammer GD, Doherty GM. Resection of adrenocortical carcinoma is less complete and local recurrence occurs sooner and more often after laparoscopic adrenalectomy than after open adrenalectomy. Surgery. 2012;152:1150–7.

    Article  PubMed  Google Scholar 

  49. Cooper AB, Habra MA, Grubbs EG, Bednarski BK, Ying AK, Perrier ND, Lee JE, Aloia TA. Does laparoscopic adrenalectomy jeopardize oncologic outcomes for patients with adrenocortical carcinoma? Surg Endosc. 2013;27:4026–32.

    Article  PubMed  Google Scholar 

  50. Mir MC, Klink JC, Guillotreau J, Long JA, Miocinovic R, Kaouk JH, Simmons MN, Klein E, Krishnamurthi V, Campbell SC, Fergany AF, Reynolds J, Stephenson AJ, Haber GP. Comparative outcomes of laparoscopic and open adrenalectomy for adrenocortical carcinoma: single, high-volume center experience. Ann Surg Oncol. 2013;20:1456–61.

    Article  PubMed  Google Scholar 

  51. Lombardi CP, Raffaelli M, De Crea C, Boniardi M, De Toma G, Marzano LA, Miccoli P, Minni F, Morino M, Pelizzo MR, Pietrabissa A, Renda A, Valeri A, Bellantone R. Open vs endoscopic adrenalectomy in the treatment of localized (stage I/II) adrenocortical carcinoma: results of a multiinstitutional Italian survey. Surgery. 2012;152:1158–64.

    Article  PubMed  Google Scholar 

  52. Donatini G, Caiazzo R, Do Cao C, Aubert S, Zerrweck C, El-Kathib Z, Gauthier T, Leteurtre E, Wemeau JL, Vantyghem MC, Carnaille B, Pattou F. Long-term survival after adrenalectomy for stage I/II adrenocortical carcinoma (ACC): a retrospective comparative cohort study of laparoscopic versus open approach. Ann Surg Oncol. 2014;21:284–91.

    Article  PubMed  Google Scholar 

  53. Lombardi CP, Raffaelli M, Boniardi M, De Toma G, Marzano LA, Miccoli P, Minni F, Morino M, Pelizzo MR, Pietrabissa A, Renda A, Valeri A, De Crea C, Bellantone R. Adrenocortical carcinoma: effect of hospital volume on patient outcome. Langenbeck’s Arch Surg. 2012;397(2):201–7.

    Article  Google Scholar 

  54. Economopoulos KP, Phitayakorn R, Lubitz CC, Sadow PM, Parangi S, Stephen AE, Hodin RA. Should specific patient clinical characteristics discourage adrenal surgeons from performing laparoscopic transperitoneal adrenalectomy? Surgery. 2016;159(1):240–8.

    Article  PubMed  Google Scholar 

  55. Coste T, Caiazzo R, Torres F, Vantyghem MC, Carnaille B, Do Cao C, Douillard C, Pattou F. Laparoscopic adrenalectomy by transabdominal lateral approach: 20 years of experience. Surg Endosc. 2017;31(7):2743–51.

    Article  PubMed  Google Scholar 

  56. Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, Reinke CE, Morgan S, Solomkin JS, Mazuski JE, Patchen Dellinger E, Itani KMF, Berbari EF, Segreti J, Parvizi J, Blanchard J, Allen G, Kluytmans JAJW, Donlan R, Schecter WP, Healthcare Infection Control Practices Advisory Committee. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784–91.

    Article  PubMed  Google Scholar 

  57. Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO. VTE, thrombophilia, antithrombotic therapy, and pregnancy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e691S–736S.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  58. Babic B, De Roulet A, Volpe A, Nilubol N. Is VTE prophylaxis necessary on discharge for patients undergoing adrenalectomy for Cushing syndrome? J Endocr Soc. 2018;3(2):304–13.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Gaur DD. Laparoscopic operative retroperitoneoscopy: use of a new device. J Urol. 1993;149:973–6.

    Google Scholar 

  60. Mercan S, Seven R, Ozarmagan S, Tezelman S. Endoscopic retroperitoneal adrenalectomy. Surgery. 1995;118:1071–107.

    Article  PubMed  CAS  Google Scholar 

  61. Giebler RM, Walz MK, Peitgen K, Scherer RU. Hemodynamic changes after retroperitoneal CO2 insufflation for posterior retroperitoneoscopic adrenalectomy. Anesth Analg. 1996;82:827–31.

    PubMed  CAS  Google Scholar 

  62. Walz MK, Peitgen K, Hoermann R, Giebler RM, Mann K, Eigler FW. Posterior retroperitoneoscopy as a new minimally invasive approach for adrenalectomy: results of 30 adrenalectomies in 27 patients. World J Surg. 1996;20:769–74.

    Article  PubMed  CAS  Google Scholar 

  63. Walz MK, Alesina PF, Wenger FA, Deligiannis A, Szuczik E, Petersenn S, Ommer A, Groeben H, Peitgen K, Janssen OE, Philipp T, Neumann HPH, Schmid KW, Mann K. Posterior retroperitoneoscopic adrenalectomy-results of 560 procedures in 520 patients. Surgery. 2006;140:943–50.

    Article  PubMed  Google Scholar 

  64. Dickson PV, Jimenez C, Chisholm GB, Kennamer DL, Ng C, Grubbs EC, Evans DB, Lee JE, Perrier ND. Posterior retroperitoneoscopic adrenalectomy: a contemporary American experience. J Am Coll Surg. 2011;212(4):659–65.

    Article  PubMed  Google Scholar 

  65. Gavriilidis P, Camenzuli C, Paspala A, Di Marco AN, Palazzo FF. Posterior retroperitoneoscopic versus laparoscopic transperitoneal adrenalectomy: a systematic review by an updated meta-analysis. World J Surg. 2020;45(1):168–79. https://doi.org/10.1007/s00268-020-05759-w.

    Article  PubMed  Google Scholar 

  66. Lombardi CP, Raffaelli M, De Crea C, Bellantone R, Fusco A, Bianchi A, Pontecorvi A, De Marinis L. ACTH-dependent Cushing’s syndrome: the potential benefits of simultaneous bilateral posterior retroperitoneoscopic adrenalectomy. Surgery. 2011;149(2):299–300.

    Article  PubMed  Google Scholar 

  67. Raffaelli M, Brunaud L, De Crea C, Hoche G, Oragano L, Bresler L, Bellantone R, Lombardi CP. Synchronous bilateral adrenalectomy for Cushing’s syndrome: laparoscopic versus posterior retroperitoneoscopic versus robotic approach. World J Surg. 2014;38:709–15.

    Article  PubMed  Google Scholar 

  68. Walz MK, Petersen S, Koch JA, Mann K, Neumann HPH, Schmid KW. Endoscopic treatment of large primary adrenal tumours. Br J Surg. 2005;92:719–23.

    Article  PubMed  CAS  Google Scholar 

  69. Piazza L, Caragliano P, Scardilli M, Sgroi AV, Marino G, Giannone G. Laparoscopic robot-assisted right adrenalectomy and left ovariectomy (case reports). Chir Ital. 1999;51:465–6.

    PubMed  CAS  Google Scholar 

  70. Hubens G, Ysebaert D, Vaneerdeweg W, Chapelle T, Eyskens E. Laparoscopic adrenalectomy with the aid of the AESOP 2000 robot. Acta Chir Belg. 1999;99:125–7.

    Article  PubMed  CAS  Google Scholar 

  71. Desai MM, Gill IS, Kaouk JH, Matin SF, Sung GT, Bravo EL. Robotic-assisted laparoscopic adrenalectomy. Urology. 2002;60:1104–7.

    Article  PubMed  Google Scholar 

  72. Brunaud L, Bresler L, Ayav A, Zarnegar R, Raphoz AL, Levan T, Weryha G, Boissel P. Robotic-assisted adrenalectomy: what advantages compared to lateral transperitoneal laparoscopic adrenalectomy? Am J Surg. 2008;195:433–8.

    Article  PubMed  Google Scholar 

  73. Brunaud L, Ayav A, Zarnegar R, Rouers A, Klein M, Boissel P, Bresler L. Prospective evaluation of 100 robotic-assisted unilateral adrenalectomies. Surgery. 2008;144:995–1001.

    Article  PubMed  Google Scholar 

  74. Giulianotti PC, Buchs NC, Addeo P, Bianco FM, Ayloo SM, Caravaglios G, Coratti A. Robot-assisted adrenalectomy: a technical option for the surgeon? Int J Med Robot. 2011;7:27–32.

    Article  PubMed  CAS  Google Scholar 

  75. Aksoy E, Taskin HE, Aliyev S, Mitchell J, Siperstein A, Berber E. Robotic versus laparoscopic adrenalectomy in obese patients. Surg Endosc. 2013;27:1233–6.

    Article  PubMed  Google Scholar 

  76. Brandao LF, Autorino R, Laydner H, Haber GP, Ouzaid I, De Sio M, Perdonà S, Stein RJ, Porpiglia F, Kaouk JH. Robotic versus laparoscopic adrenalectomy: a systematic review and meta-analysis. Eur Urol. 2014;65:1154–61.

    Article  PubMed  Google Scholar 

  77. Tang K, Li H, Xia D, Yu G, Guo X, Guan W, Xu H, Ye Z. Robot-assisted versus laparoscopic adrenalectomy: a systematic review and meta-analysis. Surg Laparosc Endosc Percutan Tech. 2015;25:187–95.

    Google Scholar 

  78. Morelli L, Tartaglia D, Bronzoni J, Palmeri M, Guadagni S, Di Franco G, Gennai A, Bianchini M, Bastiani L, Moglia A, Ferrari V, Fommei E, Pietrabissa A, Di Candio G, Mosca F. Robotic assisted versus pure laparoscopic surgery of the adrenal glands: a case-control study comparing surgical techniques. Langenbeck’s Arch Surg. 2016;401:999–1006.

    Article  Google Scholar 

  79. Economopoulos KP, Mylonas K, Stamou AA, Theocharidis V, Sergentanis TN, Psaltopoulou T, Richards ML. Laparoscopic versus robotic adrenalectomy: a comprehensive metaanalysis. Int J Surg. 2017;38:95–104.

    Article  PubMed  Google Scholar 

  80. Nomine-Criqui C, Germain A, Ayav A, Bresler L, Brunaud L. Robot-assisted adrenalectomy: indications and drawbacks. Updat Surg. 2017;69:127–33.

    Article  CAS  Google Scholar 

  81. Talamini MA, Chapman S, Horgan S, Melvin WS, Academic Robotics Group. A prospective analysis of 211 robotic assisted surgical procedures. Surg Endosc. 2003;17:1521–4.

    Article  PubMed  CAS  Google Scholar 

  82. Greilsamer T, Nomine-Criqui C, Thy M, Ullmann T, Zarnegar R, Bresler L, Brunaud L. Robotic-assisted unilateral adrenalectomy: risk factors for perioperative complications in 303 consecutive patients. Surg Endosc. 2018;33:802–10.

    Article  PubMed  Google Scholar 

  83. Kazaure HS, Roman SA, Sosa JA. Obesity is a predictor of morbidity in 1,629 patients who underwent adrenalectomy. World J Surg. 2011;35(6):1287–95.

    Article  PubMed  Google Scholar 

  84. Chen Y, Scholten A, Chomsky-Higgins K, Nwaogu I, Gosnell JE, Seib C, Shen WT, Suh I, Duh QY. Risk factors associated with perioperative complications and prolonged length of stay after laparoscopic adrenalectomy. JAMA Surg. 2018;153(11):1036–41.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Thompson LH, Nordenström E, Almquist M, Jacobsson H, Bergenfelz A. Risk factors for complications after adrenalectomy: results from a comprehensive national database. Langenbeck’s Arch Surg. 2017;402(2):315–22.

    Article  Google Scholar 

  86. Rossitti HM, Söderkvist P, Gimm O. Extent of surgery for phaeochromocytomas in the genomic era. Br J Surg. 2018;105:e84–98.

    Article  PubMed  CAS  Google Scholar 

  87. Moore EC, Berber E. Fluorescence techniques in adrenal surgery. Gland Surg. 2019;8(Suppl 1):S22–7.

    Article  PubMed  PubMed Central  Google Scholar 

  88. De Crea C, Arcuri G, Pennestrì F, Paolantonio C, Bellantone R, Raffaelli M. Robotic adrenalectomy: evaluation of cost-effectiveness. Gland Surg. 2020;9(3):831–9.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Dickson PV, Alex GC, Grubbs EG, Jimenez C, Lee JE, Perrier ND. Robotic-assisted retroperitoneoscopic adrenalectomy: making a good procedure even better. Am Surg. 2013;79(1):84–9.

    Article  PubMed  Google Scholar 

  90. Kahramangil B, Berber E. Comparison of posterior retroperitoneal and transabdominal lateral approaches in robotic adrenalectomy: an analysis of 200 cases. Surg Endos. 2018;32(4):1984–9.

    Article  Google Scholar 

  91. Kim WW, Lee YM, Chung KW, Hong SJ, Sung TY. Comparison of robotic posterior retroperitoneal adrenalectomy over laparoscopic posterior retroperitoneal adrenalectomy: a single tertiary center experience. Int J Endocrinol. 2019;2019:9012910.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Pommier RF, Brennan MF. An eleven-year experience with adrenocortical carcinoma. Surgery. 1992;112:963–70.

    PubMed  CAS  Google Scholar 

  93. Bellantone R, Ferrante A, Boscherini M, Lombardi CP, Crucitti P, Crucitti F, Favia G, Borrelli D, Boffi L, Capussotti L, Carbone G, Casaccia M, Cavallaro A, Del Gaudio A, Dettori G, Di Giovanni V, Mazziotti A, Marrano D, Masenti E, Miccoli P, Mosca F, Mussa A, Petronio R, Piat G, Marazano L, et al. Role of reoperation in recurrence of adrenal cortical carcinoma: results from 188 cases collected in the Italian National Registry for Adrenal Cortical Carcinoma. Surgery. 1997;122:1212–8.

    Article  PubMed  CAS  Google Scholar 

  94. Gaujoux S, Brennan MF. Recommendation for standardized surgical management of primary adrenocortical carcinoma. Surgery. 2012;152:123–32.

    Article  PubMed  Google Scholar 

  95. Mihai R, Iacobone M, Makay O, Moreno P, Frilling A, Kraimps JL, Soriano A, del Moral JV, Barczynski M, Durán MC, Sadler GP, Niederle B, Dralle H, Harrison B, Carnaille B. Outcome of operation in patients with adrenocortical cancer invading the inferior vena cava – a European Society of Endocrine Surgeons (ESES) survey. Langenbeck’s Arch Surg. 2012;397:225–31.

    Article  Google Scholar 

  96. Bittner JG 4th, Gershuni VM, Matthews BD, Moley JF, Brunt LM. Risk factors affecting operative approach, conversion, and morbidity for adrenalectomy: a single-institution series of 402 patients. Surg Endosc. 2013;27:2342–50.

    Article  PubMed  Google Scholar 

  97. Heger P, Probst P, Hüttner FJ, Gooßen K, Proctor T, Müller-Stich BP, Strobel O, Büchler MW, Diener MK. Evaluation of open and minimally invasive adrenalectomy: a systematic review and network meta-analysis. World J Surg. 2017;41(11):2746–57.

    Article  PubMed  Google Scholar 

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Bellantone, R., De Crea, C. (2021). Surgical Procedure: Adrenalectomy – Indications, Operative Techniques and Management of Complications. In: Shifrin, A.L., Raffaelli, M., Randolph, G.W., Gimm, O. (eds) Endocrine Surgery Comprehensive Board Exam Guide. Springer, Cham. https://doi.org/10.1007/978-3-030-84737-1_23

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