Introduction

The applications of laparoscopy in urology have expanded immensely in the last decade. Procedures that initially appeared to be immensely challenging are increasingly becoming routine. Undoubtedly, the era of minimally invasive surgery is now upon us. Laparoscopy has become the standard of care for benign surgical adrenal disease, due to its minimal invasiveness, equivalent operative time, shorter hospital stay, and faster convalescence. This is borne out of a number of retrospective and case control studies even though prospective, randomized trials are lacking (1-5). The surgical community has evolved from performing radical extirpative surgery to organ- and function-preserving surgery, without compromising the primary therapeutic goal. Such advances have occurred in many abdominal and thoracic solid organ systems, and recently in adrenal surgery. The concept of laparoscopic partial adrenalectomy or adrenal-sparing surgery includes the preservation of the functioning adrenal cortex to obviate the need for hormonal replacement therapy and its attendant, undesired consequences. The initial laparoscopic patial adrenalectomies were performed by Janetschek et al. for aldosterone-producing adenoma (6) and pheochromocytoma (7) and by Walz et al. for Cushing's adenoma (8). However, at the onset, it is clearly stated that partial adrenalec-tomy has limited application in highly selected patients, and, at this writing, is not an accepted treatment for the majority of surgical adrenal diseases.

The rich vascular supply of the adrenal makes it a highly vascularized organ. Its segmental arterial supply enables partial adrenalectomy. If the main adrenal vein needs to be sacrificed during the surgical procedure, the adrenal venous drainage gets diverted through the venae comitantes, ensuring viability of the remnant gland.

0 0

Post a comment