SURGICAL APPROACHES FOR ADRENALECTOMY

The data of literature concerning the theoretical and practical issues of current surgical approaches for adrenalectomy. According to the literature of all surgical approaches to the adrenal glands are divided into transabdominal (transperitoneal, transperitoneal, laparotomic), transthoracic (torakofrenotomnye), retroperitoneal (retroperitoneal, lumbar (side and rear), lumbar) and combined. The paper is a short description of the advantages and disadvantages of the most commonly used surgical approaches for adrenalectomy. In the analysis of the literature revealed that, despite the commitment to the development and introduction of various surgical approaches and technologies for adrenalectomy, at the moment of the ideal access to the adrenal glands do not. Studies have shown a number of domestic and foreign authors remain high rate of intraoperative complications such as bleeding from the central veins of the adrenal gland, diaphragmatic, renal and splenic blood vessels, damage to the inferior vena cava, spleen and pancreas. According to most researchers in the postoperative period in the application of open surgical approaches for adrenalectomy often develop purulent-infectious complications of the wound, pleural effusion, pleurisy, pneumonia, hemothorax, pancreatitis and peritonitis, the frequency of which are 2,7-30%. Analysis of the literature shows that the choice of surgical approach to the adrenal glands in each case should be individualized, taking into account the size of the tumor, its angioarchitectonics and morphological structure, state gormonoproduktsii and topographic anatomical relationships with adjacent organs and structures.