Navigation and design of adrenal surgery with the aid of computed tomography

This study evaluated the possibilities of designing a safe access for adrenalectomy using preoperative computed tomography navigation. The outcomes of surgical interventions in 1.457 patients with diseases of the adrenal glands requiring surgery were examined, among which 1.209 patients underwent endovideosurgery with a follow-up period of up to 20 years. Of the total number of patients, 418 were included in the analysis for the preoperative design of access for adrenalectomy using computed tomography navigation. This cohort was conditionally divided into a retrospective group (n = 157) and a prospective group (n = 261). After a comprehensive examination of patients with adrenal formations, according to the algorithm developed at the department, an integral assessment of the leading anthropometric (body mass index and physique form) and computed tomography criteria (i.e., formation diameter; tumor synthopia with respect to the walls of the inferior vena cava; length of the central adrenal vein and the place of its confluence with the lower hollow and renal veins; location of the tumor relative to the lower vein of the right lobe of the liver, as well as relative to the gate of the right kidney; location near the aortorenal vascular triangle; gate of the left kidney; and spleen vessels) allows us to justify the selection of a rational technique and the volume of the surgical treatment. Among endovideosurgical interventions, adrenalectomy from a retroperitoneoscopic access has a significant advantage because it causes the least trauma and short operating time in comparison with laparoscopic access. No intraoperative complications occurred, taking into account the planning of the access option and technique for performing adrenalectomy. Expected complications that may have occurred during adrenalectomy were damage to the central vein of the adrenal glands, renal and spleen vessels, and inferior vena cava and intraoperative blood loss. In general, an increase in operating time directly depends on the peculiarities of the location of the tumor in the adrenal gland, which can be evaluated in detail using preoperative computed tomography, making it possible to reasonably use endovideosurgical or open adrenalectomy alternatives and thus reliably improving the immediate treatment outcomes of the patients.