Diagnostic and treatment algorithm of comprehensive surgical management of patients with adrenal tumors
Background. The problematic field of application of laparoscopic adrenalectomy is to formulate universal indications and contraindications for surgery in patients with adrenal tumors. The purpose of the study is to develop diagnostic and treatment algorithm for comprehensive surgical treatment of patients with adrenal pathology using video-endoscopic interventions and to evaluate its clinical effectiveness. Materials and methods. The results of the treatment of 813 patients who underwent video-endoscopic intervention for adrenal pathology were analyzed. Results. The results of surgical interventions in the Ukrainian Research and Practical Center of Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukraine during the three main stages are analyzed. In the first phase (1995-2003), open access surgeries on the adrenal glands were carried out. The second stage (2004-2014) starts from the date of the first laparoscopic adrenalectomy at the clinic of the center. The third stage (2015-2016) is characterized by a period of implementation and use of developments in medical practice. The proposed diagnostic and treatment algorithm improved the results of managing patients with adrenal diseases due to the differentiated approach to the choice of examination methods and the determination of therapeutic tactics, the choice of surgical method. This reduced the incidence of postoperative complications to 0.5 %, postoperative mortality - up to 0.2 %, shortened the length of stay in the hospital and the time of social and labor rehabilitation of patients. Conclusions. Current approaches to the surgical treatment of adrenal diseases are based on the widespread adoption of highly effective and minimally invasive technologies, help to revise some of the traditional positions in the diagnosis and treatment. The choice of surgical access should be strictly individual and take into account the size, nature of the neoplasm, its anatomic and topographic relationship with the surrounding organs and tissues, the constitutional features of the patient.