Minimally invasive adrenal surgery

Nowadays, minimaly invasive operating techniques arp an essential part of adrenal gland surgery. Meanwhile four different methods are being used: laparoscopically in the supine or lateral position or retroperitoneoscopically as a prone or lateral method. Ideal indications for endoscopic adrenalectomy are adrenal hyperplasias and benign, hormonally active adrenal gland tumors up to 5 cm in diameter. In comparison to the conventional operating procedures, the endoscopic methods have the advantage of less blood loss and minimized postoperative pain as well as shortening of hospital stay. Yet in contrast, the operating time of these procedures is prolonged. To date, it is not evident whether laparoscopy or retroperitoneoscopy should be preferred. Laparoscopy offers a familiar anatomical exposure but requires 5-6 trocars. For the retroperitoneoscopic methods only 3 trocars are needed, but orientation in the operating field is more difficult. All endoscopic procedures on the adrenal gland are technically difficult. They require a extended experience in minimally invasive surgery as well as special knowledge in endocrine surgery.