Open Adrenalectomy

Although minimally invasive surgery has become the gold standard approach for the majority of adrenal pathologies, open adrenalectomy remains an essential tool in the endocrine surgeon’s arsenal. There are specific indications for open surgery, in which oncological and safety outcomes are superior to minimally invasive approaches, and in our tertiary referral center the rates of utilization of an open approach in the management of adrenal masses has remained stable at approximately 15% over the past 15 years. In this chapter we will discuss the indications for an open approach, informed by the literature and personal clinical experience, the important perioperative considerations, and a detailed review of the surgical anatomy and technique.