Endoscopic adrenalectomy in patients with obesity

The advantages of endosurgical techniques in the treatment of patients with adrenal tumors are obvious and require no further confirmation. On the other hand, obesity has long been considered a factor that worsens the results of endoscopic adrenalectomy, and some authors have indicated it as a contraindication to its implementation. However, the overwhelming majority of modern studies demonstrate that endoscopic adrenalectomy in obese patients does not significantly worsen the outcome. Today, two main techniques are used to perform endoscopic adrenalectomy — laparoscopic adrenalectomy (LAE) and retroperitoneoscopic adrenalectomy (RPAE). In cases of obesity, some researchers prefer LAE, as this surgical option, compared to RPAE, is less dependent on the volume of retroperitoneal fat when identifying anatomical landmarks. Based on the results of the studies, it should be noted that endoscopic adrenalectomy in obese patients is feasible and safe. Compared to operations performed in normal-weight patients, the results of these procedures generally show only a slight increase in operative time. However, in terms of complication rates and overall perioperative outcomes, the endoscopic approach retains significant advantages over the traditional approach. Regarding the prospects for further improvement of endoscopic adrenalectomy in obese patients, it is necessary to highlight the possibility of modifying some aspects of the surgical technique, such as optimizing the placement of trocars and the process of tumor dissection, which could contribute to further increasing the level of safety of endoscopic adrenalectomy in obese patients.