Open or laparoscopic adrenalectomy - When to choose what?

Adrenalectomy is traditionally viewed as one of the more challenging interventions in soft tissue surgery no matter what surgical approach is used. Approaches used in the past include a ventral celiotomy, a paracostal approach and more recently transperitoneal laparoscopic resection. While prospective controlled studies are lacking on when to choose which technique there are a multitude of factors that should influence this decision and these will be discussed in this lecture.

Endocrine testing for functionality and diagnostic imaging are critical components of the pre-operative workup for adrenal masses and form the basis for decision making as to whether surgical resection is warranted and if so which surgical approach is preferred.

Endocrine testing

Pre-operative medical treatment is a vital component of successful management of these tumors. Functional adrenocortical tumors are administered trilostane (2.5-5mg/kg BID PO) for 2-3 weeks prior to surgery. Supplementation with corticosteroids prior to initiation of surgery to avoid a hypoadrenocortical episode in the recovery period is important. Suitable choices include dexamethasone (0.1-0.2mg/kg IV), prednisolone sodium succinate (1-2mg/kg IV) or hydrocortisone (2mg/kg IV). In animals where pheochromocytoma is suspected, pre-treatment with an α-adrenergic blocker, such as phenoxybenzamine (escalating dose up to 1- 1.5mg/kg PO BID), should be considered for several weeks pre-operatively until the animal is normotensive. This drug has been shown to improve outcome in dogs undergoing adrenalectomy.¹ In cats with functional adrenocortical tumors, it has been suggested that treatment with trilostane, be initiated until the skin abnormalities, accompanying the condition in this species resolve.² Cats with aldosterone-secreting tumors should have their metabolic and electrolyte disturbances corrected prior to surgery. [...]