The Surgical clinics of North America
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The discovery of a thyroid incidentaloma warrants a systematic approach for those nodules most likely to be cancerous. An optimal management strategy for thyroid incidentalomas should be guided by four questions: (1) Does the incidentally detected thyroid nodule put the patient at risk for an adverse outcome; (2) Can those individuals with malignant thyroid nodules be identified; (3) Is the treatment of thyroid malignancy more effective in presymptomatic patients; and (4) Do the beneficial effects of presymptomatic detection and treatment in these patients justify the costs incurred Physicians caring for patients with thyroid disease should participate in data acquisition in national databases and properly randomized studies, to address the optimal management strategy in the treatment of incidentally-detected thyroid nodules.
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Laparoscopic adrenalectomy for primary malignancies and tumors metastatic to the adrenal is controversial. Most studies demonstrate that results of laparoscopic adrenalectomy for malignant lesions are similar to those of open adrenalectomy, without its morbidity. ⋯ Diagnostic laparoscopy may be useful, and in some cases, may establish a diagnosis. Laparoscopic adrenalectomy should be cautiously performed, with the goals of achieving complete tumor resection without disruption of the adrenal capsule.