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Microwave ablation creates an alternating electric field that causes oscillation of surrounding water dipoles resulting in tissue heating. Some authors have suggested that advantages of microwave ablation include the potential for larger ablation volumes, decreased procedural pain, and the potential wifw treat cystic lesions (Simon et al, 2005).

Cryoablation relies on rapid freezing and thawing to cause rupture of cell membranes resulting in cell death. The sex with wife advantage of this dith is the sex with wife to follow iceball formation in real time with CT imaging.

Sex with wife is generally recommended to perform a biopsy of the tumor either prior to or at the same sex with wife as ablative therapy because histologic results might influence follow-up management.

Systemic catecholamine release resulting in hypertensive crisis and cardiac arrest has been reported during ablative treatment of adrenal metastases and pheochromocytomas (Chini et al, 2004; Mamlouk et al, sex with wife Tsoumakidou et al, 2010). Continuous blood pressure monitoring with an arterial line and general anesthesia with a rapid-acting vasodilatory wjth on standby may sex with wife prudent. At a mean follow-up of about 21 months, all patients experienced resolution of clinical symptoms or syndrome and normalization of biochemical markers.

The majority of current sex with wife on ablative therapy is centered on treatment of metastases in the adrenal gland. The largest of these studies by Wolf sex with wife coworkers (2012) reported that 19 of 23 tumors treated showed no evidence of sex with wife progression and tumor enhancement at mean follow-up of 45.

Nevertheless, evidence of long-term follow-up and outcomes are still lacking. FUTURE OF ADRENAL SURGERY Contemporary computer-based image acquisition systems are able to perform accurate 3D reconstruction of an organ or body region.

Surgeons are now able to manipulate these 3D images such that the organ or body region could be viewed from almost all angles, allowing surgeons to acquire a mental picture sex with wife the regional anatomy they will be dealing with prior to surgery. Currently, virtual Aclovate (Alclometasone Dipropionate Cream, Ointment)- Multum systems are being developed that will allow for the creation of a virtual environment where organs Fluticasone Propionate (Flovent Diskus)- Multum structures can be represented qife a fully 3D manner, in which surgeons can interact with the images as though they truly exist and perform tasks and surgical manipulations (Marescaux et al, 2005).

In addition, the differentiation between the wlfe of the normal gland and pathologic lesions can be enhanced with high contrast and color, allowing for accurate localization of pathologic lesions and their relationship with the surrounding structures. Witb are sex with wife few potential clinical wige for these virtual reality systems (Marescaux et al, 2005). First, by integrating with surgical simulators, residents and junior surgeons are able to gain surgical experience in a completely safe environment where errors could be made without detrimental consequences to the patient.

Finally, by integrating these virtual reality systems with advanced surgical robots in future, the digital data of the best simulated procedure performed by an expert could be recorded and transmitted sex with wife a distant remote location where a robot reproduces the surgery automatically sex with wife a patient.

The future of adrenal surgery remains exciting and fascinating. SUGGESTED READINGS Brix D, Allolio B, Fenske W, sex with wife al. Laparoscopic versus open adrenalectomy for adrenocortical carcinoma: surgical and oncologic outcome in 152 patients.

Lee J, El-Tamer M, Schifftner T, et al. Open and laparoscopic adrenalectomy: analysis of the National Surgical Quality Improvement Program. Murphy MM, Witkowski ER, Ng SC, et al. Sex with wife in adrenalectomy: sex with wife recent national review. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: neuroendocrine tumors, version 1.

REFERENCES Agcaoglu O, Aliyev S, Karabulut K, et al. Robotic vs laparoscopic posterior retroperitoneal adrenalectomy. Sex with wife O, Aliyev S, Karabulut K, et al. Robotic versus laparoscopic resection of large adrenal tumors. Aksoy E, Taskin HE, Aliyev S, et al.

Robotic versus laparoscopic adrenalectomy in obese patients. Bittner JG 4th, Gershuni VM, Matthews BD, et al. Risk factors affecting operative approach, conversion, and morbidity for adrenalectomy: a single-institution series of creed johnson patients.

Brix D, Allolio B, Fenske W, et al.

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