Adrenal surgical techniques.

SUMMARY The broad variety of lesions of the adrenal glands constitutes a surgical challenge to the urologist. Essential to successful surgery is an understanding of anatomy, physiology, pharmacology, and endocrinology associated with adrenal disorders. The individual vagaries of a given endocrinopathy may evoke special considerations relating to the surgical approach employed in a given patient. Several surgical approaches to the adrenal may be utilized: the flank approach, common to both renal and adrenal surgery, is relatively simple and familiar but affords limited access to the ipsilateral and contralateral adrenal; the thoracolumbar or transthoracic approach is most useful in extensive tumors and malignant entities involving the adrenal; the transabdominal approach offers advantages in pheochromocytoma, neuroblastoma, and exploration for ectopic adrenal tissue; and the posterior approach, either unilateral or bilateral, may be employed most commonly in dealing with the usual adrenal tumors encountered. Critical to successful adrenal surgery are appropriate endocrinologic management and the skillful application of advanced techniques of anesthesiology. Operative and postoperative complications of adrenal surgery are relatively few, can be anticipated and avoided in most instances, and are both recognizable and manageable by standard techniques when presenting in the postoperative interval. Applications of modern techniques of adrenal surgery will afford gratifying results in the care of patients with a variety of both functioning and nonfunctioning adrenal disorders.