Adrenalectomy

Abstract

An excellent preoperative medical preparation of the patient is the key. We typically optimize the patient with calcium channel blockers, with secondary use of alpha-1 blockers and beta blockers in select circumstances. Cardiovascular clearance is essential. Vigorous intravenous hydration, early control of the adrenal vein, and minimal handling of the tumor are essential aspects of surgery. If adequate experience with retroperitoneoscopy is not available, the transperitoneal approach should be preferred in that circumstance. At our institution, we would approach the adrenal pheochromocytoma either transperitoneally or retroperitoneally without any general preference for either approach. Another key approach to adrenal surgery is to stay outside the periadrenal fat, thereby minimizing or completely avoiding handling of the adrenal gland per se, which will uniformly lead to adrenal gland fracture with troublesome hemorrhage.