Purpose of review 

Review the literature on the surgical management of adrenal diseases, highlighting the various surgical approaches and their respective pros and cons.

Recent findings 

Minimally invasive adrenalectomy is commonly used for small and benign adrenal tumors, whereas open adrenalectomy is preferred for larger tumors and primary adrenal malignancy. Although minimally invasive adrenalectomy results in shorter recovery and fewer complications compared with open, the latter offers better oncologic outcomes in the setting of primary adrenal malignancy. Adrenalectomy is performed transabdominally or retroperitoneoscopically, both yielding equivalent results and recovery. Traditional laparoscopic or robotic equipment can be utilized for either minimally invasive approach. Subtotal adrenalectomy may be appropriate for patients with genetically associated pheochromocytoma to preserve cortical function and reduce the risk of adrenal insufficiency. However, the potential benefits of sparing adrenal function must be weighed against the risk of recurrence.

Summary 

Adrenalectomy is becoming increasingly common worldwide. For benign and small adrenal tumors, minimally invasive adrenalectomy is generally considered the standard approach, while open adrenalectomy is preferred for primary adrenal malignancy and larger tumors. Subtotal adrenalectomy may be appropriate for patients with bilateral adrenal pheochromocytoma, as it can reduce the need for lifelong glucocorticoid dependency.

中文翻译：

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肾上腺的手术方法

审查目的 

回顾肾上腺疾病手术治疗的文献，重点介绍各种手术方法及其各自的优缺点。

最近的发现 

微创肾上腺切除术通常用于小型良性肾上腺肿瘤，而开放式肾上腺切除术则首选用于较大肿瘤和原发性肾上腺恶性肿瘤。尽管与开放式肾上腺切除术相比，微创肾上腺切除术恢复时间更短，并发症更少，但后者在原发性肾上腺恶性肿瘤中提供了更好的肿瘤学结果。肾上腺切除术通过经腹或后腹膜镜进行，两者产生相同的结果和恢复。传统的腹腔镜或机器人设备可用于微创方法。肾上腺次全切除术可能适合患有遗传相关嗜铬细胞瘤的患者，以保留皮质功能并降低肾上腺功能不全的风险。然而，必须权衡保留肾上腺功能的潜在益处与复发风险。

概括 

肾上腺切除术在世界范围内变得越来越普遍。对于良性和小型肾上腺肿瘤，微创肾上腺切除术通常被认为是标准方法，而开放性肾上腺切除术是原发性肾上腺恶性肿瘤和较大肿瘤的首选。肾上腺次全切除术可能适合双侧肾上腺嗜铬细胞瘤患者，因为它可以减少终生糖皮质激素依赖的需要。