Chirurgie de la surrénale : de l'incidentalome au corticosurrénalome malin

Laparoscopic adrenalectomy has become the preferred method for removal of almost all adrenal tumors. An important component in selecting patients for this operation is to understand the clinical presentation (mostly hypertension) and diagnostic workup for the various functioning and non-functioning adrenal tumors including genetic evaluation when necessary (NEM2, VHL, NF1, SDH and NEM1). The indications and contraindications for laparoscopic approach are discussed for each tumor type. Relevant literature about partial and bilateral adrenalectomy is also summarized. Main areas of controversy including the threshold size to avoid adrenal capsular effraction and the appropriateness of laparoscopic resection for suspected and known malignancy are discussed. This article presents recent data to help the surgeon to make well-informed decisions and to optimize approach, accounting for the variations in adrenal pathology (secreting / not secreting and benign / malignant tumors).