Subtotal adrenalectomy (SA) has been described as an alternative approach to classic laparoscopic adrenalectomy in the treatment of unilateral primary aldosteronism (UPA) caused by a single adenoma. However, there are controversies regarding its indication and technical difficulties. The aim of our study is to demonstrate that SA is technically feasible and allows cure in UPA with correct preoperative and intraoperative evaluation and to analyze its outcomes at our center.

A retrospective study was designed on a prospective registry database of a cohort of patients who underwent SA for UPA between 2021-2023. SA indication criteria: age <50, absence of risk factors for familial hyperaldosteronism, macronodular single adenoma < 3.5cm and positive lateralization. Mandatory adjuncts: preoperative study with thin-slides CT scan and adrenal venous sampling, intraoperative ultrasound gland and specimen evaluation, intraoperative pathological analysis of the specimen and verification of remnant gland vascularization with ICG. Primary Aldosteronism Surgery Outcome investigators consensus1 was used to determine cure.

5 patients underwent SA. 80% were male, mean age 44(SD 3.7). Mean adrenal nodule size was 1,1(1,1.7) cm and pathological report showed 4 adrenal adenoma vs 1 micronodular hyperplasia. All patients stayed 1 day at hospital without complications. With a median follow-up time of 6(4,8) months: 3 patients reached clinical remission and biochemical cure, 1 reached clinical improvement and biochemical cure and 1 clinical improvement without biochemical cure.

SA is technically feasible and allows clinical and biochemical cure in patients properly selected by a meticulous preoperative study and supported by findings obtained from intraoperative adjuncts.