PARTIAL LAPAROSCOPIC ADRENALECTOMY - ANATOMICAL BASIS AND OPERATION TECHNIQUE

The aim: To optimize the indications for partial laparoscopic adrenalectomy (PLA), to give a detailed outline of a PLA technique and to provide technical tips to ensure safe and highly-effectiveness, based on the knowledge of adrenal anatomy and blood supply. Materials and methods: Between January 2010 and September 2018, our department performed 47 adrenal glands surgeries. The operations included 29 total laparoscopic adrenalectomies (TLA), 4 open adrenalectomies (OA) and 14 partial laparoscopic adrenalectomies (PLA). Results: The histopathological examination of all operated patients detected 9 (19.1%) malignant tumors, including 5 metastatic tumors. Benign tumors includes 24 (63%) adenomas, 8 (21%) pheochromocytomas, 4 (10,5%) cysts and 2 (5,5%) ganglioneuromas. Post-PLA histopathological findings revealed 6 adenomas, 2 pheochromocytomas, 4 cysts and 2 ganglioneuromas. Conclusions: Keeping in mind anatomical features of adrenal gland blood supply in highly-selected patients, PLA can be performed in a number of patients. 2 mm of a minimal resection margin is enough to preserve a false tumor recurrence. Anatomically grounded PLA is becoming a new standard of benign adrenal gland tumors treatment, providing an opportunity to save more adrenal gland functional tissue and to prevent hipocorticism development in postoperative period.