the acme was a make of american automobiles made in reading , pennsylvania from 1903 to 1911 .

they were the successor of the reber which was made from 1902 to 1903 by reber manufacturing .

acme ( automobile )

1904 acme the acme was an american automobile produced by the the acme motor car co . of reading , pa from 1903 to 1910 . the acme was formerly the re… | pinteres…
acme insight is a registered trademark of acme infovision systems pvt . ltd . all rights reserved 2015
referenced in bugs bunny ' s birthday ball , where acme corporation includes the acme rocket co .
acme’s insight software allows distributor to import published price list on manufacturing web sites . please contact acme’s office or acme’s business partner’s office how to import it .
acme cars competed in the land ' s end economy run of the long island automobile club in early 1908 . [ 54 ]
from business : acme portable machines was founded in 1994 in los angeles . acme has exclusive distributors in the united states , europe and asia . acme has been proven effective i…
when mr . myers purchased acme livery service in 2006 acme was operating a fleet of 16 limousines and 14 funeral coaches .
1909 mason delivery wagon mason automobile co . des moines , ia 1908 - 1910
eventually the automobile change the face of small town america ; and the world .
1912 moline touring moline automobile co . e . moline , il 1904 - 1919
acme’s insight software is completely driven by stock data . acme’s insight software allows distributor to add multiple attributes or properties for each item .
also in 1965 acme purchased a new 1965 superior – cadillac 3–way funeral coach which is still owned by acme as of this writing .
parodied in the mini - series fresno , where the acme toxic waste company is owned by . . . . . mr acme .
hiring branch manager for a leading automobile industry * . in automobile sales and service with sound technical knowledge , should have managed 2 to 3 branch . . . .
in who framed roger rabbit the president of the acme corporation is a nice chap , marvin acme , whose lost will becomes the macguffin .
defictionalization : you can get yourself a copy of an acme catalog , detailing some of the various acme items from the looney tunes cartoons .
1905 union side entrance tonneau union automobile co . union city , in 1902 - 1905
1905 model type b model touring model automobile co . peru , in 1903 - 1909
1909 alco six race car american locomotive automobile co . providence , ri 1905 - 1913
one such company was the marlboro automobile and carriage co . in marlborough , ma .
rare early automobile publication - the pneus - march 1906 vol . 2 no . 2
rare early automobile publication - the pneus - may 1906 vol . 2 no . 4
acme livery service continued growing and purchasing new model funeral vehicles and again as the 1980’s were ushered in acme livery service continued to lead the way .
1916 simplex model 5 simplex automobile co . inc . new brunswick , nj 1907 - 1917
seen here is a fleet image of acme henney - packard funeral vehicles and limousines . these vehicle models were operated by acme livery company ( not acme ambulance service ) . acme livery company at this time was still owned by mr . merithew and was located at 1009 troost ave . mr . hughes at the time only owned and operated acme ambulance service which was a separate company .
the acme automobile was built in reading , pennsylvania from 1903 - 1911 . in 1908 the company sent this car to savannah to complete in the races being held there .
1903 oldsmobile advertisement in more ways than one , this advertisement foretold the future of the automobile .
1925 franklin sedan body designed by dietrick and made by walker automobile co . , amesbury , ma
the boyertown museum of historic vehicles ' new exhibit outlines the history of the acme manufacturing company , founded in 1892 by james reber , which first manufactured bicycles . the company would later become the acme motor car company after building its first automobile in 1900 .
acme’s insight allows distributor to lock the sales rates while selling products to retailers .
save acme to get e - mail alerts and updates on your ebay feed .
1941 had an acme turpentine warehouse . had as in before it got wrecked .
acme products are very common in several shorts and movies of the three stooges .
acme over their malfunctioning equipment , and was awarded a prime - time slot .
1905 acme opera limousine acme motor car co reading pennsylvania activ 1903 - - 1910 4 - 6 | oldtimers 1900 - 1980 part 1 . america | pinterest | cars
in 1909 the acme was built in three different types . the acme “sextuplet” type xx 5 - 7 passenger touring car equipped with a six cylinder engine and… | pinteres…
1905 apperson side entrance tonneau wth cover apperson bros . automobile co . kokomo , in 1902 - 1924
harry wilcox driving his 1907 wolf automobile wilcox motor co . , minneapolis , mn . 1907 - 1909
who owned a machine shop into helping him build an automobile . three were built and they were runabouts
1913 inter - state model 45 inter - state automobile co . muncie , ind . 1909 - 1914
1913 simplex toy tonneau 4 passenger simplex automobile co . inc . new brunswick , nj 1907 - 1917
the gun shop in the good , the bad and the ugly sells acme gunpowder .
to help further the growth of acme livery service and acme ambulance service , acme entered into an agreement to offer air ambulance service and special airport limousine service . although acme did not actually own the airplanes , they were used on an “as need” on - call rental agreement . helping acme with this arraignment was dr . mcnally who besides being a medical doctor was an avid aviator and a close personal friend of mr . hughes .
even chip n dale rescue rangers had an acme product : the acme majestic ultra - light all - weather fiberglass volcano as shown in the episode
gadget goes hawaiian
.
the first closed circuit automobile race held at narragansett park , rhode island , in september 1896 . : -
bank reconciliation is one of the most tedious tasks for every business owner . acme’s insight software offers a feature by which bank reconciliation happens in lesser time . kindly contact acme’s office or acme’s partners office to see how this feature helps business owner and save owners time .
for more details on the acme and s . g . v , please click here .
acme’s insight software allows distributor to check margin on every item for the entered purchase bill .
vintage rolyal acme date stamper , cleveland , 5 . 5
high x 2
across
1909 geneva ewing taxi ewing automobile company , geneva , oh . dates unknown , purchased by general motors in 1909
immediate opening for automobile engineering . job location is based on company . freshers can also apply . . . .
716 f2d 1476 international union united automobile aerospace and agricultural implement workers of america uaw v . yard - man incorporated
finally in 1945 walter merithew sold acme livery company to mr . lawrence v . hughes thus merging the livery company and ambulance service into one company . walter merithew however retained ownership of acme drive yourself and the acme mechanic garage and gas station which are show early in the article .
acme exhibited its cars at the chicago automobile shows from 1904 to 1907 . [ 4 ] [ 5 ] the company was one of the founding members of the american motor car manufacturers association . [ 6 ]
acme’s insight software allows distributor to validate purchase rate and sale rate while entering automobile spare part data . this feature empower & educate users to validate accuracy of price factor that is utmost important to the business .
all acme automobiles came with a year ' s
absolute binding guarantee .
[ 46 ]
acme’s insight software allows distributor to view sales history of every retailer while sales bill is generated .
wasting no time lawrence v . hughes of acme ambulance also traveled to kosiusko , mississippi in june 1961 to take delivery of three new 1961 superior - pontiac consort ambulances for the acme fleet .
1905 maxwell delivery truck maxwell - briscoe automobile co . , tarrytown , ny and detroit , mi . 1904 - 1924
1915 crane - simplex model 5 farnham - nelson torpedo touring simplex automobile co . new brunswick , nj 1915 - 1924
the invention , therefore , provides an automobile ( or other conveyance ) access and ignition system that combines leading edge automobile computer functions with the latest development in portable memory devices and cell phone technology . further , the invention provides for an automobile ignition system that uses such portable memory devices for unique applications that are presently not available in the automotive field .
entering purchase bill consumes huge time of distributor or staff . to save time , efforts , avoiding mistakes & errors , acme’s insight software allows distributor to import supplier’s bill generated on computers in csv format . please contact acme’s office or acme’s business partner’s office to understand how to use this feature .
in 1927 acme auto livery service purchased a fleet of new 1927 model hupmobile’s . acme was setting itself apart from other livery services by purchasing new fleet vehicles even if they were an economy line vehicle
1912 s . g . v . roadster acme motor car co . reading , pa 1911 - 1915
s i ' ve had as far as getting a issue fixed . would i do business with acme
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painter ( automobile painter ) . accommodation will be provided from the company side at the free of cost . . . .
716 f2d 1476 international union united automobile aerospace and agricultural implement workers of america uaw v . yard - man incorporated | openjurist
trips to the factory were no longer as frequent because with the large number of vehicles acme was purchasing each year the vehicles were simply mass delivered on multiple car carriers to acme’s front door . these sayers & scovill’s were sold to acme by lloyd hatfield of midwest s & s auto sales of kansas city .
a need exists , therefore , for an automobile ignition system that combines leading edge automobile computer functions with the latest development in portable memory drives or cell phone technology . further , a need exists for an automobile ignition system that uses such portable memory devices for unique applications that are presently not available in the automotive field , such as a method for managing a transportation fleet .
acme like other ambulance services of the day also took advantage of the spare tire cover on their vehicles and used it to proudly display their company name as seen in this image below of acme’s 1937 buick .
seen below are images inside the acme garage and a few of the many vehicles acme operates , as the images clearly show there is never enough room under the round - top to fit all the cars .
a somewhat odd example in bachelor mother , in which acme isn ' t making products . when polly gets fired from her christmas seasonal job , the temp agency she returns to is called acme employment services .
acme’s insight offers another unique feature to distributors that allows distributors to import purchase order data , delivery challan data , invoice data and price list data being used by distributor directly on web based software application being made compulsory to use it for distributors . it is being found that most of these applications do not allow distributor to do other business activities in real time . acme understood this need and developed a link in acme’s insight software . kindly contact acme’s office or acme’s business partner’s office on how to bridge this business gap .
to know more about company please contact us : . hiring body shop manager for a leading automobile industry * . . . .
to know more about company please contact us : . hiring customer care manager for a leading automobile industry * . . . .
716 f . 2d 1476 - international union united automobile aerospace and agricultural implement workers of america uaw v . yard - man incorporated
acme’s insight offers this unique function by which distributor comes to know about sales bills delivered on retailer route .
( below ) one of the newly delivered 1961 superior pontiac consorts ambulances in front of acme offices in kansas city mo . with ambulance staff standing in front of vehicle . notice the acme name on the building .
karl ( left ) and larry hughes ( right ) at the old acme office in november of 1992 .
acme is a 5⭐ shop done business with those guys . . . their pretty dam good . . .
roy and simon use acme products several times during their cartoon battles in the cartoon man and its sequel .
a circa 1978 national lampoon article also had wile e . suing acme over the integrity of their products .
tiny toon adventures is set in a town called acme acres . guess what product brand is always used .
the beetles were not the only music group to use the services of acme livery service , during the 1960’s while the beach boys were on tour and performing in kansas city they also requested acme’s limousine services however their special request was not for a limousine but rather a van which fit their beach going image . acme didn’t disappoint and luckily acme owned a white customized van which proved to be the perfect vehicle for the special request .
this radiator emblem belonged to an apperson automobile that was manufactured by the apperson brothers automobile company of kokomo , indiana sometime between 1904 and 1926 . the four cylinder jack rabbit automobile was one of apperson’s more popular vehicles , and the jack rabbit was used in their promotional materials from 1909 onward . this emblem likely dates to post 1909 , and features a leaping jackrabbit over the text “apperson . ”
motorcars were a relatively new mode of transportation at the dawn of the twentieth century and , although automobiles had been around for several years , private automobile ownership was still something only for the rich or well established businesses…something the average joe could only dream of . with the advent of the ford model t in october 1908 and its low cost and fast assembly line production the model t changed the entire automobile industry and the world we live in . with the automobile still in its infancy , in 1909 walter merithew established acme – which operated as a livery service and one of the first car rental businesses in the state of missouri . acme “drive your self” was the rental car division while acme auto livery was the livery service .
acme offices and garage located at 2528 holmes street is where acme operated the livery and ambulance service . this location served the company well for many years . the only issue with acme’s location is there never seemed to be enough space in the garage to fit all the cars . with their ambulance service , acme used a wide variety of vehicles and mr . hughes was not opposed in operating a variety of car manufactures for their ambulance fleet .
rollin white left the white company shortly after his father died and started building tractors , cletracs tractor co . , cleveland . his tractor business which became one of the best in the busines . in 1923 , he reentered into automobile manufacturing with his 1923 rollin automobile .
this function allows user to check last purchase rate and last sales rate given for designated retailer who want to buy automobile spare parts .
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( above ) acme’s livery service consisted of a fleet of new 1927 hupmobiles shown in this post car image .
acme’s insight software offers another powerful feature that can be used before or after transaction hours . distributor can also add various important business task like vat return date , it return date , vat payment date , it payment date , etc . in acme’s scheduling software . acme’s scheduling software sends an alert text message on mobile phones used by distributor .
stuart wells - not on the way to anywhere , fleetwood : the early years , automobile quarterly , vol . 33 , no . 3
frank n . potter - of heart and wheels , antique automobile , vol . 42 , nos . 1 - 6 , pub . 1978
with the end of wwii came a huge economic boom and once again business and manufacturing were increasing at a never before seen pace . acme like other companies began to benefit from the improved economy and before long mr . hughes was able to fulfill his goal of buying new vehicles for acme , a trend that would last even today with acme .
during the 1980’s acme livery service also began purchasing vehicles from southwest professional vehicles out of dallas texas . the myer family had purchased southwest professional vehicles in 1981 from gordon k . allen . mr . myers and his son sean developed a close professional relationship with larry hughes and acme livery service over the years of selling professional cars to acme livery service .
this radiator emblem belonged to an ace model automobile that was manufactured by the continental automobile company of grand rapids , michigan during 1933 and 1934 . the continental motors corporation manufactured a variety of engines for numerous automobile manufacturers during the early 20th century . in 1932 continental motors took over the de vaux - hall company and produced the continental - de vaux brand automobile . in 1933 the continental automobile company began to produce their own vehicles . three models were produced at three different price points , the budget ( $ 395 ) beacon , the mid - range ( $ 510 ) flyer , and the high - end ( $ 816 ) ace . the curved emblem has a red background and reads “ace” with in silver .
while the automobile business was slowing down for white , the trucks were very popular and were gloabal sellers . when the war started , white closed down its automobile business and began making vehicles for the u . s . government . their truck manufacturing continued after the war an ceaed in 1985 .
building companies include acme building brands , makes of the famous brick , as well as paint company benjamin moore & co .
in quest for camelot ruber has a potion that turns his minions into metal monsters , and its labeled acme on it .
parodied in the carmen sandiego franchise , which gives the
acme
label to a detective agency rather than a product .
acme industrial garbage containers , as seen in nineteen seventy seven the comic . also , air horns and even exotic pets .
one of the products found in an early 20th century sears , roebuck and co . catalog is an actual acme anvil .
the benson ford research center in dearborn , michigan has a 48 page catalog of automobile bodies , published by the reading metal body company in 1908 .
acme insight for distributors is effective tool & fast sales billing software for managing mobile sales , routewise functioning & accounts payable receivables .
acme’s insight software got this another unique and needy feature . this feature send stock reports to marketing representatives using their email id’s .
acme’s insight software allows distributor to lock retailer in case retailer’s business reputation is spoil because of wrong business practices followed by retailer .
in 1954 acme ambulance service purchased an almost matched pair of 1954 superior - pontiac long - wheelbase ambulances . superior began building pontiacs at its mississippi bus plant in 1953 and this provided a new trip destination for acme to pick up new vehicles . acme operated their ambulances in an all white color scheme the entire span of their ambulance service after lawrence v . hughes purchased the company .
acme’s insight software maintains product data batch wise ( here batch means production date or month or year ) and category wise . this process helps distributor and billing user while making sales bill , while taking sales return and while returning automobile spare parts to the stockiest or to production company .
for our leading iso certification company . dme / b . e mech / b . e automobile * . _ dear job seekers : . . . .
by this time james c . reber had left the firm he founded a decade earlier ( acme ) in order to get into the automobile body business . reading body’s incorporation was announced to the trade via the following announcement in the july 20 , 1905 issue of the iron trade review :
ed foster : welcome to another royal automobile club talk show in association with motor sport . i’m ed foster and i’m the online editor at motor sport magazine .
this feature report automobile spare parts that are already expired or near to expire . this alert appears on computer screen as soon as acme’s insight software is started . this alert helps distributor to take quick action on expired goods . owner can immediately return the products to stockiest or to producing company .
to illustrate the history of this company , two late 19th - century bicycles will be on display , as well as a 1910 acme race car and a 1912 s . g . v automobile . sales literature and brochures from these companies will also be displayed and incorporated into the exhibit signage .
acme insight is user friendly software for wholesaler & which support multi company billing , multiple sales prices , inventory & balance sheet accounting .
can someone provide me the birth / death years for james c . reber , the acme car co . owner ? johnschoenfelder @ urltoken
acme’s insight print date & time on each report so that trailing on each report becomes easy . this function is available via settings .
these are direct factory sales numbers from accubuilt regarding vehicles acme purchased during the 80’s and early 1990’s and where they were purchased through .
below is armbruster - stageway cadillac crown landau operated by acme livery service . this photo was taken in front of kansas city union station
the madagascar video game has a few acme products , mainly a cardboard box which you use to sneak past people as the penguins .
in december of 1972 another beloved us president passed away and again acme livery service was there to assist in another prestigious presidential funeral . this time acme supplied on contract a new funeral coach to carson’s funeral home of independence , missouri for president harry s . truman’s funeral .
automobile ignition systems , as well as onboard computer systems , have changed dramatically in the last decade . for example , many modern automobiles no longer use keys with unique physical features in order to enable ignition systems . rather , the automobile senses electronic data from , for example , a chip within the ignition key or a chip installed on a credit card sized data device kept in the driver ' s wallet . this electronic data enables the ignition system in the automobile like the traditional key .
to know more about company please contact us : . in automobile work shops with sound technical knowledge , should have managed workshops with service load of 1000 . . .
cehaich v . international union , united automobile , aerospace and agricultural implement workers of america , 710 f . 2d 234 at 239 ( 6th cir . 1983 ) .
lawrence hughes is seen in the picture ( below ) third from the left along with acme staff members posing next to their new vehicles .
seen below is acme’s 1958 desoto standard - wheelbase sedan ambulance conversion pulling into st joseph’s hospital in kansas city which was located at prospect ave . at linwood . again acme operated an all white fleet of ambulances regardless of what manufacture or coach builder the ambulance was produce by .
( below ) two new 1974 superior - cadillac 54″ rescuer ambulances . note the names on the name boards are different for some reason as one reads “kc ambulance” while the other reads “acme ambulance” . again both ambulances were all white as the acme ambulance fleet had always been .
the present invention relates to a portable memory drive or device used ( in one embodiment ) as a substitution of an automobile ( or other engine driven conveyance ) key , and an integrated onboard computer and ignition system . specifically , the invention relates to the use of a portable memory drive or device containing data which is downloaded to an onboard processing system in communication with the automobile ' s ignition system , and other systems ( such as the automobile ' s entertainment system , door lock system , and navigation system ) and how , in one embodiment , this innovation can be integrated in a method for managing a transportation fleet , such as an automobile rental service .
acme’s insight offers this unique feature that helps distributor on how to upload automobile spare parts in delivery van . this sheet helps business staff to upload those items ( first ) that are going to get delivered last and upload those items ( last ) that are going to get delivered first on defined retailer’s route .
mr . hughes also enjoyed these trips outside of kansas city to meet other business owners and to learn what was new in the industry . acme was a pioneer in many ways when it came to professional vehicles . on one hand acme would buy a top of the line professional car whether it be an ambulance or funeral coach and then their next purchase might be a mid price range vehicle just to give that company some business while at the same time allowing acme to have a very diverse feet . acme was always looking for new avenues to expand their business .
acme insight for retailers proves to be a effective tool for managing busy counters , maximum sales in minimum stock , customer relationship management and accounting .
a few years ago , philippe grümmer discovered a trunk of magazines , pictures and records relating to his father’s work as a coachbuilder , and he recognised their significance in the history of the automobile . after writing several articles on the subject and seeing the possibility of a major book he approached the automobile historian laurent friry to write it with him .
after mr . hughes was able to pay off his loans and the business had become more manageable mr . hughes set off to make acme ambulance service into a first class company . however with the turn of events into wwii the entire economy took a turn as automobiles and metal were very limited . if this wasn’t enough in 1942 acme lost one of its ambulances in a wreck . their 1937 buick was badly damaged when it was involved in an automobile accident .
in november , 1989 the matriarch of acme livery service alma boehm hughes ( lawrence v . hughes’ wife ) died . her passing left an incredible void due to her loving and maternal instincts and direction over the many years . it was only fitting that acme provide the funeral vehicles for her funeral . for acme this was probably the most important funeral they had serviced , more so than even the presidents and music stars they had served .
site supervisor is responsible for maintaining overall quality of a plant project . he will ensure the work is done as per standard automobile procedures supervisor is responsible for timely - finish task
crank shaft grinding machine , cylinder reboring machine , engine line boring machine , connecting rod boring machine , valve refacer and universal cylinder , grinding machine ( for automobile industry ) .
may 30 , 2011 at 2 : 11 pm · filed under 1929 orphan vehicles ·tagged automobile , automobile business , automobiles , babcock , buffalo , carriage company , commercial bodies , company , delivery van , dodge , dodge brothers , early 1900s , h . h babcock , henry holmes , lincoln , new york , sainte claire , truck , watertown new york
acme insight for retailers proves to be a effective tool for & managing busy counters , maximum sales in minimum stock , customer relationship management and accounting .
acme introduced its first 6 - cylinder car , a touring car called the sextuplet , at the new york motor show in september 1907 . [ 16 ] acme also increased its involvement in motor racing through 1908 . in 1909 it introduced a 10 - year guarantee on its 6 - cylinder models .
corrugated box making machinery . ( also marketed through their sister concern m / s . acme machinery company p ltd . , ( said address ) .
older than television : harold lloyd comedy never weaken ( 1921 ) , in which harold uses
acme soap flakes
to make a road slippery .
s . g . v . - the acme motor car co . / s . g . v . the acme motor car co . reading , pa 1911 - 1912 the s . g . v . co . reading , pa 1913 - 1915 the s . g . v . succeede… | pinteres…
with tom’s leadership and with lawrence v . and karl hughes beside him , together they worked diligently to expand and grow acme as the baby - boom generation and the overall us economy was at one of its largest expansions in history . the economy was in full force which benefited almost everyone including acme .
by 1960 acme was continuing to grow and lawrence vincent hughes wife , alma boehm hughes worked in the acme office and kept everything running smooth as seen in this image below taken in june of 1960 . alma simply went by the name “boehm” which is noted in many of the images within this article .
acme - insight , not only takes care of your day - to - day tasks ; but also you can mould the software as per your needs .
using this function , acme’s insight can send personal greeting messages for entire retailer database . e . g . happy birthday , happy wedding anniversary , etc .
by the mid 1920’s car sales were steadily growing and roads were improving to handle the steady growth of new traffic . people were on the move and “acme drive - yourself” offered an option to people who didn’t yet own a vehicle . acme livery also offered local undertakers motorized funeral cars through their livery service .
this same image above was then used in promotional advertisements which were sent out around town , below is just one example of these many advertisements acme used .
here is another image i found on the web . it is a prototype of a 1900 reber automobile . no other details but if i hear more i ' ll let you know .
reber ' s father got on board the bicycle craze and in 1894 the pair organized the acme bicycle company , james t . serving as president and james c . as secretary and general manager . acme manufactured the ' pennant ' and ' stormer ' bicycles ( unrelated to the acme cycle co . of elkhart indiana ) until the firm ' s factory and machinery were destoryed by fire on march 24 , 1897 , causing aloss of $ 75 , 000 . the rebers entered into an agreement with the american bicycle co . who continued to construct acme ' s pennant and stormer bicycles into 1899 while the plant was rebuilt .
generating sales bill is the foundation stone of distribution business . generating sales bill for every sale creates meaningful data ( about product , about producing company , about quantity , about price , about margin , about profitability , about packaging , etc . ) that empowers & educate health of the business to the business owner . acme infovision understand this aspect of business since acme started back in year 1994 . acme infovision supply one of the best sales billing user interface for the distribution business . current user interface of billing allows business owner to generate 10 sales bills at a time in one single screen . this feature of acme’s insight is helping more than 1000 + distributors across maharashtra state and karnatak state . acme infovision appeals every business owner to use sales billing feature every day and for every product .
acme entered a car in motor races in atlanta city on the 26 to 30 april 1906 . it was described as a new model that had just been tested . [ 49 ] in a 1907 race at reading the acme car driven by edward lange was beaten by a pullman driven be robert morton . [ 50 ]
original magazine ad , 8 x 5 . 5 , has some tape at tear on edge . produced by the acme motor car company , reading , pennsylvania .
in 2007 acme livery moved into their current location after extensive remodeling . with the remodel there’s just a nice historical presence to the building and the new location lends itself to the historic company which occupies it . however like their old location acme livery service still never seems to have enough room in their large garage for all their vehicles . this lack of garage space which has always been a constant issue was partially solved by a business plan which larry hughes initiated when he was operating acme .
acme sold its site and plant to j h sternbergh for $ 72 , 100 in may 1911 . [ 18 ] sternbergh in turn sold the acme motor car company and leased it plant to a new york consortium . the company ' s name was changed to sgv [ 19 ] sternbergh died in march 1913 . [ 20 ]
the acme ( conceived 1892 ) was a model of chain - driven touring auto made by the reber manufacturing co in reading , pennsylvania , from 1903 to 1911 .
while acme and physicians exchange were the two largest ambulance and livery services in kansas city both owners ( eugene desaulniers of physicians exchange and lawrence v . hughes and larry b . hughes of acme ) were good friends and often helped each other out . this friendship even extended to them sharing equipment between companies when the need arose .
and in the latest sequel one of our thursdays is missing thursday has a sort - of part - time job in a carpet fitting company which is called acme .
in the great santa claus caper , the big bad wolf ( whose real name is revealed as
alexander graham wolf
) has invented a substance called
gloopstik
and even created a company to manufacture it . however , his business card reveals that the gloopstik corporation is owned by acme , making gloopstik an acme product .
balance sheet , profit & loss , trial balance , creditor’s list and debater’s list are the important documents that display health of distribution business . these reports are available on click of mouse button . the best thing about acme’s insight is ! distributor , accountant or staff does not have to have accounting knowledge to generate these reports . acme’s insight is developed in such a way that if distributor , accountant and staff enter every purchase bill , sale every product via insight , enter every payment + receipt + expenses in insight , enter every sales return and purchase return using acme’s insight ! these reports will be automatically updated as soon as these entries are recorded in acme’s insight .
the acme motor car co . of reading , pa built cars from 1903 to 1910 . this company had no connection to the acme built by the hoffman brothers in minnesota from 1908 to 1911 . since there were two automobile companies in the united states with the same name around the same time , some sources like wikipedia have reported the history of this car incorrectly by blending facts from the two companies together . the advertisements i have posted here pertain to the reading , pa company , i don’t own any ads or literature from the minnesota automaker .
garford marketed the same chassis , equipped with reading coachwork , as the garford automobile . the automobile market was expanding in 1910 and garford began reserving more and more chassis for its dealers , creating a tenuous relationship with the indiana manufacturer who was clamoring for more chassis . studebaker rectified the situation in late 1910 through the purchase of e - m - f , thereby ending its nearly 7 - year relationship with garford .
acme’s insight can generate & print mailing list of all retailers who are buying products from distributor . acme’s insight can also generate & print retailer’s information in mailing label format . these labels can be used by distributor to send them information about new products , about new scheme ( if any ) , etc . by post and / or by courier .
acme’s insight understands the security aspect . acme offers user - friendly security features that can be used using mouse button clicks . distributor can create users based on duties to be performed by the staff . e . g . , user is allowed to create sales bill . now this user will not be able to see and use features and functions of accounting , stock , purchase , accounting , etc . acme’s insight allows distributor not to allow sales billing user to have access to any other functions & features available in insight .
his brother , earnest was the general manager of the acme motor car co . at worcester in 1912 . it was a delearship for knox and velie automobiles . he also owned the wheeler ' s screw press . although not building cars , he would do special work on a knox and velie for a customer and slip his acme name to it .
printed reports give an opportunity to distributor to work out various strategies to increase business ( top line , bottom line , suppliers , products , consumers , etc . ) . printed reports ( somehow ) got more impact that is emotional to every indian mind than seeing the same report electronically on computer monitor . acme’s insight provides some standard reports . in addition , acme’s insight also provide report writing module . using this module , distributor can generate customized reports as per the need of business . following reports are available in acme’s insight namely
caption on the front of the post card reads – six new hupmobiles of the acme auto livery recently bought from w . c . howard motor co . kansas city mo .
in 1993 acme livery service is seen below taking delivery of several of their new fleet vehicles . these s & s victoria model f450 funeral cars retailed for $ 62 , 686 . these ( 5 ) funeral coaches totally $ 250 , 000 . 00 dollars were the first part of a larger vehicle order which acme was accustom to placing each year .
eugene d . desaulniers , 87 , of kansas city , mo , passed away july 8 , 2014 . eugene had owned and operated physicians exchange ambulance service up until its merger with asi ( ambulance services inc . ) asi was a joint partnership with larry b . hughes ( acme ambulance ) and hadley reimel . after asi was acquired by the city eugene worked for the irs and then for acme livery service in the office up until the week of his passing . eugene was part of the acme family for many years and his recent passing leaves an indelible mark both on acme livery service and kansas city history . a special posthumous thank you is extended to eugene for is early assistance on this article .
international union , united automobile , aerospace , and agricultural implement workers of america ( uaw ) , and local 134 , uaw , plaintiffs - appellees , v . yard - man , incorporated , defendant - appellant .
once the portable memory device is in communication with the onboard computer , further data transmission can occur with other automobile systems . by way of example , music files can be accessed that have been stored on the portable memory device for playback on the automobiles stereo system via the onboard computer . likewise , video files that have been stored on the portable memory device can be accessed for playback on the automobile ' s installed video equipment .
seen here is a calendar that acme drive yourself company provided as advertisement in 1947 indicating that mr . merithew apparently sold the company to a mr . sandusky and mr . taylor .
cartoons , especially the wile e . coyote and road runner shorts , in which the coyote orders tons of products from acme that he tries to use to catch the road runner .
it became necessary in 1906 to separate the automobile department from its parent company to accommodate the growth of the business and to physically separate them , as a fire in the paint department of one could ruin both operations .
this feature automatically selects the batch number & batch date of the selected automobile spare part in sales bill . please be noted . batch number & batch means production date , month , batch & year of the product .
in preferred embodiments , the invention utilizes as a mass storage device , or “portable memory device , ” a usb portable flash drive or cell phone containing unique data as a substitute for an automobile door / ignition key . this unique data , in combination with the portable memory device , provides numerous unique features to the automobile when all systems are integrated , including an onboard central processing unit , and are in communication with said portable memory device . in one embodiment , the portable memory device is inserted in a receiving port installed on the automobile . this receiving port can be , for example , a usb port located near or on the steering column in a location traditionally used for an ignition key and in the door in the location traditionally used for a door key . this receiving port can also be a cell phone or mp3 docking station resident somewhere inside the automobile . the portable memory device is inserted in such port by the driver . the port is connected to an onboard computer or central processing unit which initiates a read step in order to read security data from the portable memory device required to begin the automobile ignition sequence or unlock the door . if such data is available on the memory device , the automobile can be started as if the physical key has enabled a standard ignition system or door lock system .
“with this new equipment , appreciate your calls for funerals trips & emergency calls . liability insurance , promptness , courtesy & service , anywhere day or night , acme auto livery - victor 1100”
acme used this idea to help set it apart from other companies and was one of the first livery service companies in the region to offer such service , a trend that other companies copied and followed . a promotional shot taken of 8 acme professional vehicles and two air service ambulance planes . this image was also used in promotional advertisements that highlighted their unique air ambulance service .
as the 1960s ushered in a new decade of style and culture acme was right there to embrace it all . by 1961 automobiles were drastically redesigned and more refined . gone were the large tail fins that defined the late 50’s and only a few models still had very mild remnants of fins . there was a new young fresh atmosphere across the entire country but in terms of funerals and ambulance service people still expected the best . acme didn’t disappoint and led the way once again during the 1960’s starting with acme taking delivery of their new fleet vehicles early on .
marketing representative working with producing firms requires this data from distributors . acme’s insight generates this report automatically at predefined time and emails it to the concerned marketing representative via email . by this feature distributor can save valuable business time in meeting marketing representatives . pending dead stock ( defective product , packaging damaged , expired product , etc . ) report is also available in acme’s insight software .
as of this writing in september 2014 acme livery service operates of fleet of over 40 professional vehicles with the majority of the vehicles being 2014 models . the acme garage can accommodate about 30 vehicles however around 20 vehicles proves to be the sufficient number which allows ease for maneuvering , parking , and accessing the vehicles and even then it can be challenging . it’s also very common to drive by the acme garage and see several of their professional vehicles parked along the street on any given day as regular operations are underway which makes these vehicles much easier to manage and access .
accounting is an integral part of every distribution business . acme’s insight offers complete accounting on click of mouse button . read below about various features that are available under accounting feature group namely : -
acme’s insight generates 4 types of vat reports namely vat paid via suppliers bill , vat collected via sales bill generated on retailers , vat difference on sales return and vat difference on purchase return .
this feature is available in the form of formula . once the formula is set by distributor ! sale price of each item can be automatically calculated by acme’s insight when purchase rate is entered .
for this wiki ' s purposes , an acme corporation is any generic corporation that seems to supply everything a character , or entire cast , uses . these supplies are , of course , acme products . not to be confused with any of the myriad non - fictional objects and entities bearing the moniker ( which is what our trope namer was making fun of at the time ) .
s & s ( sayers & scoville ) 1924 - 1930 sayers & scovill introduced the nation’s first gasoline - powered automobile ambulance at the 1907 chicago automobile show . a few years later the sayers automobile was introduced . in may of 1924 the sayers & scovill company announced that it had disposed of all of the sayers sixes remaining in stock , and henceforth would confine production to hearses , ambulances and funeral limousines . a few months later the firm was back with another car called the s & s . unlike the sayers , however , the s & s was designed almost exclusively as a bearers’ car or limousine , with passenger car use being predominantly for sunday and holiday excursions of funeral directors .
the firm commenced business at the corner of 7 th ave . and spruce st . , reading , penn . , adjacent to a siding of the phildelphia and reading railroad . the plant was located one block away from the former acme mfg . / acme motor car co . factory , two firms which reading metal body’s president , james c . reber , had earlier been associated with .
acme’s insight allows distributor to add manufacturing company names while creating supplier database . efforts invested in data entry actually help distributor or staff when purchase order is created on these suppliers . acme’s insight software shows only those product names that are linked with supplier produced by concerned producers . this feature speed up the computer performance by showing limited product names than showing entire product names produced by countless firms .
in 1953 acme hired a professional photographer to once again take pictures of their fleet for promotional purposes . these images below are of some of their new 1953 fleet taken at the base at the liberty wwi memorial in kansas city . shown in these “fleet shots” of acme’s rolling stock : three 1953 superior - cadillac landaulet funeral coaches and four 1953 cadillac fleetwood series 75 nine - passenger sedans .


adrenalectomy is the surgical removal of one or both ( bilateral adrenalectomy ) adrenal glands .

it is usually advised for patients with tumors of the adrenal glands .

the procedure can be performed using an open incision ( laparotomy ) or laparoscopic technique .

adrenalectomy

carey lc , ellison eh . adrenalectomy : technique , errors , and pitfalls .
adrenalectomy is a surgery that involves removing either one or both the adrenal glands .
the transperitoneal approach more closely mirrors the open approach to adrenalectomy and is the approach used at our institution . accordingly , this topic concentrates on transperitoneal laparoscopic left adrenalectomy .
experience of the surgeon surgeons without training in laparoscopic surgery should not perform laparoscopic adrenalectomy .
laparoscopic right adrenalectomy : adrenal gland removal . video courtesy of william w hope , md .
laparoscopic right adrenalectomy : liver retraction and dissection . video courtesy of william w hope , md .
history of prior abdominal surgery in this scenario , laparoscopic adrenalectomy may still be possible . significant scar tissue from another surgery may limit the success of the laparoscopic technique and open adrenalectomy may be needed .
mohler jl , flueck ja , mcroberts jw . adrenal insufficiency following unilateral adrenalectomy : a case report .
type of anesthesia : adrenalectomy is done under general anesthesia . you will fall asleep during the procedure .
in patients with adrenalectomy due to malignant indications require regular follow - up to check for the recurrence .
the indications for laparoscopic adrenalectomy have evolved since its initial description and subsequent wide adoption . current indications are the same for laparoscopic adrenalectomy as for open surgery , except in cases of suspected or confirmed adrenocortical carcinoma .
your doctor can explain your treatment options and discuss whether an adrenalectomy is the most appropriate treatment for you .
with adrenalectomy alone , roughly 35 % of patients with hyperaldosteronism no longer require medications for hypertension . [ 14 ]
if performed by experts in this field , laparoscopic adrenalectomy is as safe as “open” surgery in carefully selected cases .
egdahl rh , melby jc . recurrent cushing ' s disease and intermittent functional adrenal cortical insufficiency following subtotal adrenalectomy .
initially , open adrenalectomy was preferred in cases of suspected adrenocortical carcinoma . today , however , there are few absolute contraindications for laparoscopic adrenalectomy . laparoscopic approaches to the treatment of all adrenal pathologies have been successfully performed . [ 4 , 15 , 16 , 17 ] as experience with laparoscopic adrenalectomy has increased , the absolute contraindications have dwindled .
winfield hn , hamilton bd , bravo el , novick ac . laparoscopic adrenalectomy : the preferred choice ? a comparison to open adrenalectomy . j urol . 1998 aug . 160 ( 2 ) : 325 - 9 . [ medline ] .
nelson dh , meakin jw , thorn gw . acth - producing pituitary tumors following adrenalectomy for cushing ' s syndrome .
brunicardi fc , rosman pm , lesser kl , andersen dk . current status of adrenalectomy for cushing ' s disease .
nwariaku f . adrenalectomy : minimally invasive surgery ( mis ) and traditional open procedures . urltoken accessed july 9 , 2017 .
most patients take 1 to 2 weeks to recover from the laparascopic surgery and 5 to 6 weeks from an open adrenalectomy .
russell cf , hamberger b , van heerden ja , edis aj , ilstrup dm . adrenalectomy : anterior or posterior approach ?
barbara woodward lips patient education center . adrenalectomy . rochester , minn . : mayo foundation for medical education and research . 2017 .
outcomes of adrenalectomy for adrenocortical carcinoma are generally poor because this disease tends to present at an advanced stage . a large retrospective review from md anderson cancer center reported an overall survival of around 58 % , with 86 % of these cases undergoing adrenalectomy . [ 15 ]
brunt lm , doherty gm , norton ja , soper nj , quasebarth ma , moley jf . laparoscopic adrenalectomy compared to open adrenalectomy for benign adrenal neoplasms . j am coll surg . 1996 jul . 183 ( 1 ) : 1 - 10 . [ medline ] .
laparoscopic transabdominal left adrenalectomy . procedure performed by james lee , md , columbiadoctors , new york , ny . video courtesy of columbiadoctors . urltoken
laparoscopic adrenal gland removal ( adrenalectomy ) patient information from sages . society of american gastrointestinal and endoscopic surgeons . urltoken accessed aug . 21 , 2017 .
economopoulos kp , et al . laparoscopic versus robotic adrenalectomy : a comprehensive meta - analysis . international journal of surgery . 2017 ; 38 : 95 .
wu s , lai h , zhao j , chen j , mo x , zuo h , et al . laparoendoscopic single - site adrenalectomy versus conventional laparoscopic adrenalectomy : an updated meta analysis . urol j . 2016 apr 16 . 13 ( 2 ) : 2590 - 8 . [ medline ] .
type of tumor ( benign versus cancer ) when cancer of the adrenal gland is found , the technique of choice for removing the cancer is open adrenalectomy .
assalia a , gagner m . laparoscopic adrenalectomy . br j surg . 2004 oct . 91 ( 10 ) : 1259 - 74 . [ medline ] .
chai yj , woo jw , kwon h , choi jy , kim sj , lee ke . comparative outcomes of lateral transperitoneal adrenalectomy versus posterior retroperitoneoscopic adrenalectomy in consecutive patients : a single surgeon ' s experience . asian j surg . 2016 apr . 39 ( 2 ) : 74 - 80 . [ medline ] .
bruining ha , lamberts sw , ong eg , van seyen aj . results of adrenalectomy with various surgical approaches in the treatment of different diseases of the adrenal glands .
wang ds , terashi t . laparoscopic adrenalectomy . urol clin north am . 2008 aug . 35 ( 3 ) : 351 - 63 , vii . [ medline ] .
gumbs aa , gagner m . laparoscopic adrenalectomy . best pract res clin endocrinol metab . 2006 sep . 20 ( 3 ) : 483 - 99 . [ medline ] .
indications for adrenalectomy may seem straightforward at first . however , with the increasing rates of diagnosis of asymptomatic and likely benign adrenal masses , management still remains controversial . [ 10 ]
in cases of widely metastatic disease with a concomitant adrenal mass , tissue diagnosis should be obtained before the decision is made to proceed with adrenalectomy because primary adrenal carcinoma is rare .
cohen kl , noth rh , pechinski t . incidence of pituitary tumors following adrenalectomy . a long - term follow - up study of patients treated for cushing ' s disease .
sho s , yeh mw , li n , livhits mj . single - incision retroperitoneoscopic adrenalectomy : a north american experience . surg endosc . 2016 nov 8 . [ medline ] .
laparoscopic adrenalectomy ( la ) is the procedure of choice for surgical management of the adrenal masses . our objective is to show a standardized assessment of perioperative complications in one la series .
although laparoscopic surgery has become the treatment of choice for the majority of incidentally detected adrenal masses , open adrenalectomy still plays an important role in the armamentarium of adrenal surgeons . [ 1 ]
after an adrenal lesion is identified , it is imperative to determine the specific diagnosis . this is critical , in that the indications for adrenalectomy are twofold : tumor functionality and malignant potential .
strebel rt , müntener m , sulser t . intraoperative complications of laparoscopic adrenalectomy . world j urol . 2008 dec . 26 ( 6 ) : 555 - 60 . [ medline ] .
li qy , li f . laparoscopic adrenalectomy in pheochromocytoma : retroperitoneal approach versus transperitoneal approach . j endourol . 2010 sep . 24 ( 9 ) : 1441 - 5 . [ medline ] .
an alternative approach to laparoscopic surgery is a posterior retroperitoneoscopic adrenalectomy ( pra ) , in which surgeons make small incisions in your back . sometimes surgeons use the robotic da vinci surgical system to perform laparoscopic adrenalectomies .
conzo g , et al . minimally invasive approach for adrenal lesions : systematic review of laparoscopic versus retroperitoneoscopic adrenalectomy and assessment of risk factors for complications . international journal of surgery . 2016 ; 28 : s118 .
typically , nonfunctioning tumors smaller than 4 cm can be monitored with serial imaging ; these are unlikely to be malignant . patients with nonfunctioning tumors 4 - 6 cm in size should be presented with the options of serial imaging or laparoscopic adrenalectomy . the decision regarding treatment should be individualized . patients with a solitary adrenal metastasis and no evidence of other metastatic disease are also candidates for laparoscopic adrenalectomy . [ 23 , 24 ]
gagner m , lacroix a , bolté e . laparoscopic adrenalectomy in cushing ' s syndrome and pheochromocytoma . n engl j med . 1992 oct 1 . 327 ( 14 ) : 1033 . [ medline ] .
macgillivray dc , shichman sj , ferrer fa , malchoff cd . a comparison of open vs laparoscopic adrenalectomy . surg endosc . 1996 oct . 10 ( 10 ) : 987 - 90 . [ medline ] .
mohammad wm , frost i , moonje v . outpatient laparoscopic adrenalectomy : a canadian experience . surg laparosc endosc percutan tech . 2009 aug . 19 ( 4 ) : 336 - 7 . [ medline ] .
gagner m , lacroix a , bolte e . laparoscopic adrenalectomy in cushing ' s syndrome and pheochromocytoma . n engl j med . 1992 oct 1 . 327 ( 14 ) : 1033 . [ medline ] .
agha a , von breitenbuch p , gahli n , piso p , schlitt hj . retroperitonenscopic adrenalectomy : lateral versus dorsal approach . j surg oncol . 2008 ; 97 ( 1 ) : 90 - 93 .
a retrospective study of 201 patients who underwent either minimally invasive or open surgical adrenalectomy for adrenocortical carcinoma at 13 tertiary care cancer centers found that the minimally invasive approach was an acceptable alternative for tumors no larger than 10 cm . [ 21 ] however , the authors recommended that open adrenalectomy be performed in cases where there is preoperative or intraoperative evidence of local invasion or where enlarged lymph nodes are noted , regardless of size .
surgeons may perform an adrenalectomy through minimally invasive ( laparoscopic ) or traditional open surgery , or use cryoablation . the procedure they recommend depends on the size and type of tumor or the condition affecting your adrenal gland .
surgit o . clipless and sutureless laparoscopic adrenalectomy carried out with the ligasure device in 32 patients . surg laparosc endosc percutan tech . 2010 apr . 20 ( 2 ) : 109 - 13 . [ medline ] .
murphy mm , witkowski er , ng sc , et al . trends in adrenalectomy : a recent national review . surg endosc . 2010 oct . 24 ( 10 ) : 2518 - 26 . [ medline ] .
nau p , demyttenaere s , muscarella p , et al . pheochromocytoma does not increase risk in laparoscopic adrenalectomy . surg endosc . 2010 nov . 24 ( 11 ) : 2760 - 4 . [ medline ] .
bulus h , uslu hy , karakoyun r , koçak s . comparison of laparoscopic and open adrenalectomy . acta chir belg . 2013 may - jun . 113 ( 3 ) : 203 - 7 . [ medline ] .
bergamini c , martellucci j , tozzi f , valeri a . complications in laparoscopic adrenalectomy : the value of experience . surg endosc . 2011 dec . 25 ( 12 ) : 3845 - 51 . [ medline ] .
naya y , nagata m , ichikawa t , et al . laparoscopic adrenalectomy : comparison of transperitoneal and retroperitoneal approaches . bju int . 2002 aug . 90 ( 3 ) : 199 - 204 . [ medline ] .
sartori pv , romano f , uggeri f , et al . energy - based hemostatic devices in laparoscopic adrenalectomy . langenbecks arch surg . 2010 feb . 395 ( 2 ) : 111 - 4 . [ medline ] .
after laparoscopic adrenalectomy , patients may be discharged from the hospital as early as the day after surgery . patients with cushing ' s syndrome may be asked to stay for 2 to 3 days to begin their steroid taper ( i . e . slowly lowering the amount of steroid pills they are taking ) . on the other hand , after open adrenalectomy , patients stay 3 to 5 days on average , mainly to help control post - operative discomfort .
boylu u , oommen m , lee br , thomas r . laparoscopic adrenalectomy for large adrenal masses : pushing the envelope . j endourol . 2009 jun . 23 ( 6 ) : 971 - 5 . [ medline ] .
hanssen we , kuhry e , casseres ya , de herder ww , steyerberg ew , bonjer hj . safety and efficacy of endoscopic retroperitoneal adrenalectomy . br j surg . 2006 ; 93 ( 6 ) : 715 - 719 .
bolli m , oertli d , staub jj , harder f . laparoscopic adrenalectomy : the new standard ? . swiss med wkly . 2002 jan 12 . 132 ( 1 - 2 ) : 12 - 6 . [ medline ] .
lee gs , arghami a , dy bm , mckenzie tj , thompson gb , richards ml . robotic single - site adrenalectomy . surg endosc . 2016 aug . 30 ( 8 ) : 3351 - 6 . [ medline ] .
gupta pk , natarajan b , pallati pk , gupta h , sainath j , fitzgibbons rj jr . outcomes after laparoscopic adrenalectomy . surg endosc . 2011 mar . 25 ( 3 ) : 784 - 94 . [ medline ] .
open surgery : in open surgery , the skin incision is single and large . it is mainly required for large tumors , in patients with history of abdominal surgery with adhesions and if the adrenal gland is invisible during laparoscopic adrenalectomy .
schell sr , talamini ma , udelsman r . laparoscopic adrenalectomy for nonmalignant disease : improved safety , morbidity , and cost - effectiveness . surg endosc . 1999 jan . 13 ( 1 ) : 30 - 4 . [ medline ] .
rubinstein m , gill is , aron m , et al . prospective , randomized comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy . j urol . 2005 aug . 174 ( 2 ) : 442 - 5 ; discussion 445 . [ medline ] .
gallagher sf , wahi m , haines kl , et al . trends in adrenalectomy rates , indications , and physician volume : a statewide analysis of 1 , 816 adreanlectomies . surgery . 2007 ; 142 ( 6 ) : 1011 - 1021 .
in addition , open adrenalectomy is the treatment of choice for patients in whom laparoscopic surgery is contraindicated . a patient ' s inability to undergo pneumoperitoneum is an absolute contraindication for laparoscopy . multiple previous abdominal operations and obesity remain relative contraindications for laparoscopy .
the outcomes of open adrenalectomy vary with the pathology of the disease process , and morbidity changes according to the approach chosen . approaches that limit access to the peritoneum greatly decrease the rates of postoperative ileus ; however , vascular control is often difficult .
hazzan d , shiloni e , golijanin d , jurim o , gross d , reissman p . laparoscopic vs open adrenalectomy for benign adrenal neoplasm . surg endosc . 2001 nov . 15 ( 11 ) : 1356 - 8 . [ medline ] .
rieder jm , nisbet aa , wuerstle mc , tran vq , kwon eo , chien gw . differences in left and right laparoscopic adrenalectomy . jsls . 2010 jul - sep . 14 ( 3 ) : 369 - 73 . [ medline ] .
henry jf , defechereux t , raffaelli m , lubrano d , gramatica l . complications of laparoscopic adrenalectomy : results of 169 consecutive procedures . world j surg . 2000 nov . 24 ( 11 ) : 1342 - 6 . [ medline ] .
brix d , allolio b , fenske w , et al . laparoscopic versus open adrenalectomy for adrenocortical carcinoma : surgical and oncologic outcome in 152 patients . eur urol . 2010 oct . 58 ( 4 ) : 609 - 15 . [ medline ] .
gill is , meraney am , thomas jc , sung gt , novick ac , lieberman i . thoracoscopic transdiaphragmatic adrenalectomy : the initial experience . j urol . 2001 jun . 165 ( 6 pt 1 ) : 1875 - 81 . [ medline ] .
yoshimura k , yoshioka t , miyake o , matsumiya k , miki t , okuyama a . comparison of clinical outcomes of laparoscopic and conventional open adrenalectomy . j endourol . 1998 dec . 12 ( 6 ) : 555 - 9 . [ medline ] .
vargas hi , kavoussi lr , bartlett dl , wagner jr , venzon dj , fraker dl , et al . laparoscopic adrenalectomy : a new standard of care . urology . 1997 may . 49 ( 5 ) : 673 - 8 . [ medline ] .
boris rs , gupta g , linehan wm , pinto pa , bratslavsky g . robot - assisted laparoscopic partial adrenalectomy : initial experience . urology . 2011 apr . 77 ( 4 ) : 775 - 80 . [ medline ] . [ full text ] .
perretta s , allemann p , asakuma m , dallemagne b , marescaux j . adrenalectomy using natural orifice translumenal endoscopic surgery ( notes ) : a transvaginal retroperitoneal approach . surg endosc . 2009 jun . 23 ( 6 ) : 1390 . [ medline ] .
pamaby cn , chong ps , chisholm l , farrow j , connell jm , o ' dwyer pj . the role of laparoscopic adrenalectomy for adrenal tumours of 6 cm or greater . surg endosc . 2008 ; 22 ( 3 ) : 617 - 621 .
gagner m , lacroix a , prinz ra , bolte e , albala d , potvin c . early experience with laparoscopic approach for adrenalectomy . surgery . 1993 dec . 114 ( 6 ) : 1120 - 4 ; discussion 1124 - 5 . [ medline ] .
miccoli p , raffaelli m , berti p , materazzi g , massi m , bernini g . adrenal surgery before and after the introduction of laparoscopic adrenalectomy . br j surg . 2002 jun . 89 ( 6 ) : 779 - 82 . [ medline ] .
cindolo l , gidaro s , neri f , tamburro fr , schips l . assessing feasibility and safety of laparoendoscopic single - site surgery adrenalectomy : initial experience . j endourol . 2010 jun . 24 ( 6 ) : 977 - 80 . [ medline ] .
most of the aforementioned approaches to adrenalectomy are in their infancy , with only the initial experiences of select surgeons documented . the two most commonly used approaches remain transperitoneal and retroperitoneal laparoscopic adrenalectomy , each of which has its own inherent benefits and shortcomings . some authors have found the retroperitoneal approach to be faster and associated with lower blood loss in the setting of pheochromocytoma . [ 32 ] others have attempted to exclude adrenal pathology as a confounding factor and have found transperitoneal to be faster with a shorter learning curve . [ 33 ]
munver r , del pizzo jj , sosa re . adrenal - preserving minimally invasive surgery : the role of laparoscopic partial adrenalectomy , cryosurgery , and radiofrequency ablation of the adrenal gland . curr urol rep . 2003 ; 4 ( 1 ) : 87 - 92 .
adrenalectomy is the removal of one or both adrenal glands . there is one adrenal gland on top of each kidney . the adrenal glands make several hormones , including cortisol , aldosterone , and sex steroids . the adrenal glands also make adrenaline and noradrenaline in small amounts .
thompson sk , hayman av , ludlam wh , deveney cw , loriaux dl , sheppard bc . improved quality of life after bilateral laparoscopic adrenalectomy for cushing’s disease : a 10 - year experience . ann surg . 2007 ; 245 ( 5 ) : 790 - 794 .
ortega j , sala c , garcia s , lledo s . cost - effectiveness of laparoscopic vs open adrenalectomy : small savings in an expensive process . j laparoendosc adv surg tech a . 2002 feb . 12 ( 1 ) : 1 - 5 . [ medline ] .
rieder jm , nisbet aa , wuerstle mc , tran vq , kwon eo , chien gw . differences in left and right laparoscopic adrenalectomy . jsls . 2010 jul - sep . 14 ( 3 ) : 369 - 73 . [ medline ] . [ full text ] .
berber e , tellioglu g , harvey a , mitchell j , milas m , siperstein a . comparison of laparoscopic transabdominal lateral versus posterior retroperitoneal adrenalectomy . surgery . 2009 oct . 146 ( 4 ) : 621 - 5 ; discussion 625 - 6 . [ medline ] .
cianci p , fersini a , tartaglia n , altamura a , lizzi v , stoppino lp , et al . spleen assessment after laparoscopic transperitoneal left adrenalectomy : preliminary results . surg endosc . 2016 apr . 30 ( 4 ) : 1503 - 7 . [ medline ] .
adrenal surgery has a long history , with the first planned adrenalectomy performed in 1914 by sargent . [ 2 ] chrles mayo performed the first flank approach for pheochromocytoma in 1927 , though at the time of surgery , he was unaware of the full disease process involved . through the early to mid - 1900s , multiple changes in surgical approaches to the adrenal gland were developed to augment several posterior and anterior approaches . for decades , little change to adrenal surgery was seen , until the first laparoscopic adrenalectomy was described by gagner in 1992 . [ 3 ]
the choice of approach will depend on the size and location of the mass , the possibility of malignancy , and the surgeon ' s experience with the different techniques . the open approach to adrenalectomy is considered the gold standard for masses suspected of being adrenal carcinoma . [ 2 ]
gallagher sf , wahi m , haines kl , baksh k , enriquez j , lee tm . trends in adrenalectomy rates , indications , and physician volume : a statewide analysis of 1816 adrenalectomies . surgery . 2007 dec . 142 ( 6 ) : 1011 . [ medline ] .
palazzo ff , sebag f , sierra m , ippolito g , souteyrand p , henry jf . long - term outcome following laparoscopic adrenalectomy for large solid adrenal cortex tumors . world j surg . 2006 may . 30 ( 5 ) : 893 - 8 . [ medline ] .
arghami a , dy bm , bingener j , osborn j , richards ml . single - port robotic - assisted adrenalectomy : feasibility , safety , and cost - effectiveness . jsls . 2015 jan - mar . 19 ( 1 ) : e2014 . 00218 . [ medline ] .
shen wt , grogan r , vriens m , clark oh , duh qy . one hundred two patients with pheochromocytoma treated at a single institution since the introduction of laparoscopic adrenalectomy . arch surg . 2010 sep . 145 ( 9 ) : 893 - 7 . [ medline ] .
tai ck , li sk , hou sm , fan cw , fung tc , wah mk . laparoscopic adrenalectomy : comparison of lateral transperitoneal and lateral retroperitoneal approaches . surg laparosc endosc percutan tech . 2006 jun . 16 ( 3 ) : 141 - 5 . [ medline ] .
most adrenal tumors are noncancerous ( benign ) . you may require surgery to remove an adrenal gland if the tumor is producing excess hormones or is large in size ( more than 2 inches or 4 to 5 centimeters ) . you may also require surgery if the tumor is cancerous ( malignant ) or suspected to be cancerous . this surgery is called adrenalectomy ( uh - dree - nul - ek - tuh - me ) . you may also need an adrenalectomy to remove cancer that has spread ( metastasized ) from another location , such as the kidney or lung .
saunders bd , wainess rm , dimick jb , upchurch gr , doherty gm , gauger pg . trends in utilization of adrenalectomy in the united states : have indications changed ? . world j surg . 2004 nov . 28 ( 11 ) : 1169 - 75 . [ medline ] .
thompson gb , grant cs , van heerden ja , schlinkert rt , young wf jr , farley dr . laparoscopic versus open posterior adrenalectomy : a case - control study of 100 patients . surgery . 1997 dec . 122 ( 6 ) : 1132 - 6 . [ medline ] .
chiang ph , yu cj , lee wc , wang hj , hsu wc . comparison of retroperitoneoscopic and transperitoneal laparoscopic adrenalectomy for right - sided benign tumors : a single - institute experience . urol int . 2015 . 94 ( 2 ) : 144 - 8 . [ medline ] .
ramírez - plaza cp , perales jl , camero nm , rodríguez - cañete a , bondía - navarro ja , santoyo - santoyo j . outpatient laparoscopic adrenalectomy : a new step ahead . surg endosc . 2011 aug . 25 ( 8 ) : 2570 - 3 . [ medline ] .
as a result , the only absolute contraindication for laparoscopic adrenalectomy in experienced hands is suspected adrenocortical carcinoma with extension into surrounding organs . in this setting , the open approach facilitates an en - bloc excision of all involved viscera and affords an increased chance of cure . [ 20 , 21 ]
zhang x , shi tp , li hz , ma x , wang bj . laparo - endoscopic single site anatomical retroperitoneoscopic adrenalectomy using conventional instruments : initial experience and short - term outcome . j urol . 2011 feb . 185 ( 2 ) : 401 - 6 . [ medline ] .
porpiglia f , fiori c , daffara f , zaggia b , bollito e , volante m . retrospective evaluation of the outcome of open versus laparoscopic adrenalectomy for stage i and ii adrenocortical cancer . eur urol . 2010 may . 57 ( 5 ) : 873 - 8 . [ medline ] .
moreno p , de la quintana basarrate a , musholt tj , paunovic i , puccini m , vidal o , et al . adrenalectomy for solid tumor metastases : results of a multicenter european study . surgery . 2013 dec . 154 ( 6 ) : 1215 - 23 . [ medline ] .
gockel i , kneist w , heintz a , beyer j , junginger t . endoscopic adrenalectomy : an analysis of the transperitoneal and retroperitoneal approaches and results of a prospective follow - up study . surg endosc . 2005 apr . 19 ( 4 ) : 569 - 73 . [ medline ] .
hemorrhage from the adrenal vein or ivc is one of the most feared complications of a laparoscopic right adrenalectomy . if bleeding from the adrenal vein or ivc is suspected , direct pressure usually tamponades it . during this time , planning for permanent control either by a laparoscopic or open approach can be done .
brix d , allolio b , fenske w , agha a , dralle h , jurowich c , et al . laparoscopic versus open adrenalectomy for adrenocortical carcinoma : surgical and oncologic outcome in 152 patients . eur urol . 2010 oct . 58 ( 4 ) : 609 - 15 . [ medline ] .
chung sd , huang cy , wang sm , tai hc , tsai yc , chueh sc . laparoendoscopic single - site ( less ) retroperitoneal adrenalectomy using a homemade single - access platform and standard laparoscopic instruments . surg endosc . 2011 apr . 25 ( 4 ) : 1251 - 6 . [ medline ] .
research has shown that the risk of complications in surgery is directly related to the surgeon ' s experience . since adrenal surgery is relatively uncommon , it is critical to find a surgeon who specializes in this type of operation . in experienced hands , the risks of adrenal surgery , especially laparoscopic adrenalectomy , are low .
autorino r , bove p , de sio m , miano r , micali s , cindolo l , et al . open versus laparoscopic adrenalectomy for adrenocortical carcinoma : a meta - analysis of surgical and oncological outcomes . ann surg oncol . 2016 apr . 23 ( 4 ) : 1195 - 202 . [ medline ] .
lee j , el - tamer m , schifftner t , turrentine fe , henderson wg , khuri s . open and laparoscopic adrenalectomy : analysis of the national surgical quality improvement program . j am coll surg . 2008 may . 206 ( 5 ) : 953 - 9 ; discussion 959 - 61 . [ medline ] .
an adrenalectomy is a surgical procedure to remove one or both of the adrenal glands . there are two adrenal glands in the body , located on top of the kidneys . one or both adrenal glands may be removed depending on the nature of the disease . common reasons why the adrenal gland may need to be removed include :
vidal o , astudillo e , valentini m , ginestá c , espert jj , gracía - valdecasas jc , et al . single - port laparoscopic left adrenalectomy ( sils ) : 3 years ' experience of a single institution . surg laparosc endosc percutan tech . 2014 oct . 24 ( 5 ) : 440 - 3 . [ medline ] .
despite this , surgeon preference and experience are the most important factors impacting surgical technique selection . the vast majority of the literature does not demonstrate any significant advantages when the two approaches are directly compared . [ 33 , 34 , 35 , 36 , 37 ] some experience suggests that a single - incision laparoscopic approach to left adrenalectomy may yield results comparable to those of a conventional laparoscopic approach . [ 27 ]
while most adrenal tumors can be removed laparoscopically , certain adrenal tumors should be removed through a traditional open operation . larger tumors ( usually over 10 to 15 centimeters in size ) and tumors that are thought to be adrenocortical cancer are usually removed through an open operation . patients undergoing open adrenalectomy often remain in the hospital for a few days after the operation . depending on the size and type of tumor , there are three types of open operations :
in current practice , laparoscopic adrenalectomy has generally been contraindicated in lesions 12 cm and larger . [ 17 , 18 ] nevertheless , the laparoscopic approach has been used in large adrenal masses up to 17 cm . in a report by boylu et al , [ 19 ] the use of the laparoscopic approach in lesions larger than 8 cm resulted in longer operating times and higher blood loss but was comparable when hospital stay , open conversion rate , and pathologic outcome were compared .
a commonly accepted indication for laparoscopic adrenalectomy is hormonally active tumors , including aldosteronomas , pheochromocytomas , and cortisol - producing adrenal tumors . other indications involve size criteria and include nonfunctioning tumors less than 4 - 6 cm in diameter and smaller nonfunctioning tumors with rapid or progressive growth . although no definitive size criteria for removal of nonfunctioning adrenal masses exist , it is well accepted that tumors larger than 6 cm should be removed because of an increased incidence of cancer with increasing size . [ 22 ]
other reports cited a 5 - year survival rate in the area of 33 % . [ 15 ] when stratified for stage , 5 - year survival is 20 - 45 % for stage i adrenal tumors , 12 . 5 - 57 % for stage ii adrenal tumors , 5 - 18 % for stage iii adrenal tumors , and 0 % for stage iv adrenal tumors . [ 16 ] the most significant predictors of outcome after adrenalectomy for carcinoma are stage at presentation and complete resection . [ 17 ]
the incidence of these incidentally noted adrenal masses has been estimated to be around 5 % . [ 4 , 5 , 6 , 2 , 7 ] autopsy studies have supported this estimation , showing the incidence of adrenal masses found at autopsy to also be around 3 - 5 % . [ 5 , 2 , 8 ] furthermore , studies of hospital discharges showed a 43 . 4 % increase in adrenalectomy rates from 1988 to 2000 . [ 7 , 9 ] with increasing diagnosis and treatment of adrenal masses , optimization of cure and minimization of morbidity is very important .
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perched on top of each of your kidneys , your adrenal glands produce hormones that help regulate your metabolism , immune system , blood pressure and other essential functions . although small , these glands dictate much of what happens in your body .
one adrenal gland sits above each of your kidneys . your two adrenal glands produce various hormones that help regulate your metabolism , immune system , blood pressure , blood sugar and other essential functions .
if both adrenal glands are removed , you will need to take supplemental hormone medications . if only one gland is removed , the other will take over full function without the need for ongoing medications .
minimally invasive surgery . endocrine surgeons at mayo clinic are often able to use minimally invasive ( laparoscopic ) surgery for tumors of the adrenal gland because the gland is relatively small . laparoscopic surgery has many benefits , including smaller scars , less pain and a shorter recovery period than traditional open surgery .
open surgery . doctors usually reserve open surgery for large or cancerous ( malignant ) tumors . they perform open surgery using traditional instruments and incisions .
cryoablation . in addition , mayo clinic doctors may use cryoablation to treat adrenal tumors . this procedure uses ct imaging to guide the insertion of a probe that freezes and destroys adrenal tumors . interventional radiologists may use cryoablation as a treatment option for small tumors that have spread to the adrenal gland ( metastasis ) , particularly when surgery carries a high risk .
urologic conditions . what are adrenal gland cancers ? american urological association . urltoken accessed aug . 20 , 2017 .
wein aj , et al . , eds . surgery of adrenal glands . in : campbell - walsh urology . 11th ed . philadelphia , pa . : elsevier ; 2016 . https : / / www . clinicalkey . com . accessed aug . 21 , 2017 .
warner kj . allscripts epsi . mayo clinic , rochester , minn . june 15 , 2017 .
nippoldt tb ( expert opinion ) . mayo clinic , rochester , minn . aug . 29 , 2017 .
mckenzie tj ( expert opinion ) . mayo clinic , rochester , minn . sept . 5 , 2017 .
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author : peter p stuhldreher , md ; chief editor : kurt e roberts , md more . . .
increasing use of imaging technologies , such as computed tomography ( ct ) and magnetic resonance imaging ( mri ) , for aid in diagnosis of other conditions has led to increased diagnosis of adrenal masses .
masses larger than 6 cm have a rate of adrenocortical carcinoma of 25 % and should be managed surgically . [ 8 ] masses smaller than 4 cm may be safely observed because their rate of adrenocortical carcinoma is 2 % . [ 8 ]
size categories , however , do not alter management for hormonally active lesions ; these should also be managed with surgical excision in most cases . the adrenal gland can be a common site for metastases , so patients with known primary malignancies should be managed according to guidelines for the primary malignancy by stage and grade . for example , the adrenal gland is a common site for synchronous or metachronous metastasis from renal cell carcinoma ; surgical excision can frequently offer primary cure in conjunction with nephrectomy . [ 11 ]
the adrenal glands are paired glands superior to the kidneys bilaterally ( see the image below ) that reside within a separated layer of gerota fascia , and they provide multiple functions in the body . ( see the image below . )
the outer layer ( cortex ) of the gland contributes to homeostasis via its endocrine function , secreting cortisol , aldosterone , and dehydroepiandrosterone ( dhea ) . these hormones play pivotal roles in regulating salt and water balance , and in the case of dhea add virilization hormones to the hormonal milieu . the inner layer ( adrenal medulla ) is derived from neural crest cells and is important in the sympathetic regulation of the body by secreting norepinephrine . there are several known disorders of adrenal metabolism that involve hypersecretion of these different molecules .
for more information about the relevant anatomy , see suprarenal ( adrenal ) gland anatomy .
before operative intervention , treatment for appropriate coagulopathies and for hormonal excess should be instituted . serum potassium levels should be corrected in hyperaldosteronism , and hypertension control should be initiated .
if cortisol excess is severe , inhibition of cortisol with ketoconazole , mitotane , or metyrapone should be considered . in addition , good glucose control is necessary , and operative replacement of steroids is indicated ; the hypothalamic - pituitary - adrenal axis for the normal contralateral adrenal gland will remain suppressed for some time after removal of the abnormal adrenal tissue .
for pheochromocytoma , initiation of alpha blockade with either phenoxybenzamine or prazosin is an absolute necessity to protect the patient from the sympathetic surges possible with manipulation of the mass during surgery . for the same purpose , some authors have advocated preoperative use of calcium - channel blockers . in addition , vascular volume reexpansion is often necessary because of volume contraction with hypersympathetic states .
the posterior lumbodorsal approach is also associated with high rates of neuromuscular morbidity , including chronic pain ( 14 % ) , laxity in flank muscles ( 30 % ) , and flank numbness ( 10 % ) . [ 13 ]
outcomes for benign lesions , including hormone - secreting lesions , are excellent . resolution of symptoms is achieved in nearly all patients , except those who have contralateral disease or sites of metastasis ( in the case of pheochromocytoma ) .
prager g , heinz - peer g , passler c , kaczirek k , schindl m , scheuba c , et al . surgical strategy in adrenal masses . eur j radiol . 2002 jan . 41 ( 1 ) : 70 - 7 . [ medline ] .
jossart gh , burpee se , gagner m . surgery of the adrenal glands . endocrinol metab clin north am . 2000 mar . 29 ( 1 ) : 57 - 68 , viii . [ medline ] .
barzon l , boscaro m . diagnosis and management of adrenal incidentalomas . j urol . 2000 feb . 163 ( 2 ) : 398 - 407 . [ medline ] .
grumbach mm , biller bm , braunstein gd , campbell kk , carney ja , godley pa . management of the clinically inapparent adrenal mass (
incidentaloma
) . ann intern med . 2003 mar 4 . 138 ( 5 ) : 424 - 9 . [ medline ] .
graham dj , mchenry cr . the adrenal incidentaloma : guidelines for evaluation and recommendations for management . surg oncol clin n am . 1998 oct . 7 ( 4 ) : 749 - 64 . [ medline ] .
itano nb , blute ml , spotts b , zincke h . outcome of isolated renal cell carcinoma fossa recurrence after nephrectomy . j urol . 2000 aug . 164 ( 2 ) : 322 - 5 . [ medline ] .
ranvier gg , inabnet wb 3rd . surgical management of adrenocortical carcinoma . endocrinol metab clin north am . 2015 jun . 44 ( 2 ) : 435 - 52 . [ medline ] .
blumenfeld jd , sealey je , schlussel y , vaughan ed jr , sos ta , atlas sa . diagnosis and treatment of primary hyperaldosteronism . ann intern med . 1994 dec 1 . 121 ( 11 ) : 877 - 85 . [ medline ] .
vassilopoulou - sellin r , schultz pn . adrenocortical carcinoma . clinical outcome at the end of the 20th century . cancer . 2001 sep 1 . 92 ( 5 ) : 1113 - 21 . [ medline ] .
ng l , libertino jm . adrenocortical carcinoma : diagnosis , evaluation and treatment . j urol . 2003 jan . 169 ( 1 ) : 5 - 11 . [ medline ] .
lee je , berger dh , el - naggar ak , hickey rc , vassilopoulou - sellin r , gagel rf . surgical management , dna content , and patient survival in adrenal cortical carcinoma . surgery . 1995 dec . 118 ( 6 ) : 1090 - 8 . [ medline ] .
ekici s , ciancio g . surgical management of large adrenal masses with or without thrombus extending into the inferior vena cava . j urol . 2004 dec . 172 ( 6 pt 1 ) : 2340 - 3 . [ medline ] .
barzon l , scaroni c , sonino n , fallo f , gregianin m , macri c . incidentally discovered adrenal tumors : endocrine and scintigraphic correlates . j clin endocrinol metab . 1998 jan . 83 ( 1 ) : 55 - 62 . [ medline ] .
copeland pm . the incidentally discovered adrenal mass . ann surg . 1984 jan . 199 ( 1 ) : 116 - 22 . [ medline ] .
kloos rt , gross md , francis ir , korobkin m , shapiro b . incidentally discovered adrenal masses . endocr rev . 1995 aug . 16 ( 4 ) : 460 - 84 . [ medline ] .
osella g , terzolo m , borretta g , magro g , ali a , piovesan a . endocrine evaluation of incidentally discovered adrenal masses ( incidentalomas ) . j clin endocrinol metab . 1994 dec . 79 ( 6 ) : 1532 - 9 . [ medline ] .
ross ns , aron dc . hormonal evaluation of the patient with an incidentally discovered adrenal mass . n engl j med . 1990 nov 15 . 323 ( 20 ) : 1401 - 5 . [ medline ] .
wein aj , kavoussi lr , novick ac et al . campbell - walsh urology . philadelphia : saunders , elsevier ; 2007 . 1868 - 1888 .
peter p stuhldreher , md resident physician in urology , urology institute , university hospitals , case medical center disclosure : nothing to disclose .
edward e cherullo , md director , urology residency program , vice chair , clinical operations , associate professor of urology , urologic institute , case western reserve university school of medicine edward e cherullo , md is a member of the following medical societies : alpha omega alpha , american urological association , indiana state medical association , ohio urological society , society of urology chairpersons and program directors , american association of clinical urologists disclosure : nothing to disclose .
kurt e roberts , md assistant professor , section of surgical gastroenterology , department of surgery , director , surgical endoscopy , associate director , surgical skills and simulation center and surgical clerkship , yale university school of medicine kurt e roberts , md is a member of the following medical societies : american college of surgeons , society of american gastrointestinal and endoscopic surgeons , society of laparoendoscopic surgeons disclosure : nothing to disclose .
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author : william w hope , md ; chief editor : kurt e roberts , md more . . .
relative contraindications to the laparoscopic transperitoneal approach include patients who have had extensive previous abdominal surgery and pregnant patients . in patients with previous abdominal surgery , a laparoscopic retroperitoneal approach may be beneficial .
the adrenal glands , also known as suprarenal glands , belong to the endocrine system . ( see suprarenal ( adrenal ) gland anatomy . ) they are a pair of triangular - shaped glands , each about 5 cm ( 2 in . ) long and 2 . 5 cm ( 1 in . ) wide , that sit on top of the kidneys . the suprarenal glands are responsible for the release of hormones that regulate metabolism , immune system function , and the salt - water balance in the bloodstream ; they also aid in the body’s response to stress .
each suprarenal gland is composed of two distinct tissues : the suprarenal cortex and the suprarenal medulla . the suprarenal cortex serves as the outer layer of the suprarenal gland , and the suprarenal medulla serves as the inner layer . these two major regions are encapsulated by connective tissue known as the capsule .
although many arterial branches supply the adrenal gland , most can be well controlled by using electrosurgical devices . when manipulating and removing the adrenal gland , caution must be used not to disrupt the capsule , as this can cause bleeding and potential spillage of malignant cells . although bleeding from the adrenal gland itself usually is not hemodynamically significant , it often is a nuisance , disrupting visualization for the finer dissection and making it difficult to find the correct surgical planes .
in patients with functional tumors , consultation with an endocrinologist and an anesthesiologist is crucial for adequately preparing patients for surgery and avoiding intraoperative crises , most notably severe hypertension . alpha blockade should be given to all patients with pheochromocytoma before surgery , followed by beta blockade only in patients with tachycardia .
schulick rd , brennan mf . long - term survival after complete resection and repeat resection in patients with adrenocortical carcinoma . ann surg oncol . 1999 dec . 6 ( 8 ) : 719 - 26 . [ medline ] .
schulick rd , brennan mf . adrenocortical carcinoma . world j urol . 1999 feb . 17 ( 1 ) : 26 - 34 . [ medline ] .
miller bs , ammori jb , gauger pg , broome jt , hammer gd , doherty gm . laparoscopic resection is inappropriate in patients with known or suspected adrenocortical carcinoma . world j surg . 2010 jun . 34 ( 6 ) : 1380 - 5 . [ medline ] .
gonzalez rj , shapiro s , sarlis n , vassilopoulou - sellin r , perrier nd , evans db . laparoscopic resection of adrenal cortical carcinoma : a cautionary note . surgery . 2005 dec . 138 ( 6 ) : 1078 - 85 ; discussion 1085 - 6 . [ medline ] .
[ guideline ] stefanidis d , goldfarb m , kercher kw , hope ww , richardson w , fanelli rd . sages guidelines for minimally invasive treatment of adrenal pathology . surg endosc . 2013 nov . 27 ( 11 ) : 3960 - 80 . [ medline ] .
lee cw , salem ai , schneider df , et al . minimally invasive resection of adrenocortical carcinoma : a multi - institutional study of 201 patients . j gastrointest surg . 2017 feb . 21 ( 2 ) : 352 - 362 . [ medline ] . [ full text ] .
belldegrun a , hussain s , seltzer se , loughlin kr , gittes rf , richie jp . incidentally discovered mass of the adrenal gland . surg gynecol obstet . 1986 sep . 163 ( 3 ) : 203 - 8 . [ medline ] .
podolsky er , curcillo pg 2nd . single port access ( spa ) surgery - - a 24 - month experience . j gastrointest surg . 2010 may . 14 ( 5 ) : 759 - 67 . [ medline ] .
mindy lee nace merritt , md resident physician , department of surgery , southeastern area health education center , new hanover regional medical center , wilmington , nc mindy lee nace merritt , md is a member of the following medical societies : american medical association disclosure : nothing to disclose .
james a harris , md coastal surgery specialists james a harris , md is a member of the following medical societies : american college of surgeons , society for surgery of the alimentary tract , society of american gastrointestinal and endoscopic surgeons , society of laparoendoscopic surgeons , southeastern surgical congress , american society of general surgeons disclosure : nothing to disclose .
mary l windle , pharmd adjunct associate professor , university of nebraska medical center college of pharmacy ; editor - in - chief , medscape drug reference disclosure : nothing to disclose .
medscape reference thanks william w hope , md , assistant professor of surgery , university of north carolina at chapel hill school of medicine ; director of surgical education , department of surgery , new hanover regional medical center / south east area health education center , for assistance with the video contribution to this article .
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size of tumor larger tumors are more likely to be cancer . this may require a larger incision for a more thorough dissection and removal of the cancer , including other organs it may be attached to .
the adrenal glands , which include the adrenal cortex and medulla , are located on top of the kidneys . the adrenal cortex is the outer and bigger part of the adrenal gland . it produces hormones , including glucocorticoids ( cortisol ) and mineralocorticoids ( aldosterone ) , which control the body’s metabolic process . without cortisol or aldosterone the body is not able to respond adequately under minimal physical or emotional stress , including change in temperature , exercise , or excitement .
the adrenal medulla , the inner portion of the adrenal gland , secretes the stimulants epinephrine and norepinephrine . pheochromocytoma , a tumor of the adrenal medulla , causes excessive amounts of these stimulants to be released , resulting in hypertension . pheochromocytoma is most common in young people . only a small percentage of these adrenal lesions are malignant .
depending on the underlying condition that is causing adrenal problems ( cushing ' s syndrome , pheochromocytoma ) there are steps that will be taken by your doctor to help normalize your symptoms to reduce complication risk in surgery . for example , if you have a pheochromocytoma , you ' ll be given medications to control high blood pressure and heart rate . patents with cushing ' s syndrome will receive cortisone medication .
additionally , as with many surgeries , you ' ll be asked to abstain from nsaids or other blood thinning medications to reduce risk of bleeding during surgery . your doctors will ask you to quit smoking as it will adversely affect healing after your surgery .
midnight before your surgery , you should not eat or drink anything . if you are given medications to take the day of the surgery , you should take them only with a small sip of water .
although many people feel relief from high blood pressure or other symptoms in just a few days , you will likely need to abstain from very strenuous activities for two to four weeks .
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the adrenal glands are two small organs , one located above each kidney . they are triangular in shape and about the size of a thumb . the adrenal glands are known as endocrine glands because they produce hormones . these hormones are involved in control of blood pressure , chemical levels in the blood , water use in the body , glucose usage , and the “fight or flight” reaction during times of stress . these adrenal - produced hormones include cortisol , aldosterone , the adrenaline hormones – epinephrine and norepinephrine – and a small fraction of the body’s sex hormones ( estrogen and androgens ) .
patients with adrenal gland problems may have a variety of symptoms related to excess hormone production by the abnormal gland . adrenal tumors associated with excess hormone production include pheochromocytomas , aldosterone - producing tumors , and cortisol - producing tumors . some of these tumors and their typical features are given below .
pheochromocytomas produce excess hormones that can cause very high blood pressure and periodic spells characterized by severe headaches , excessive sweating , anxiety , palpitations , and rapid heart rate that may last from a few seconds to several minutes .
aldosterone producing tumors cause high blood pressure and low serum ( blood ) potassium levels . in some patients this may result in symptoms of weakness , fatigue , and frequent urination .
cortisol producing tumors cause a syndrome termed cushing’s syndrome that can be characterized by obesity ( especially of the face and trunk ) , high blood sugar , high blood pressure , menstrual irregularities , fragile skin , and prominent stretch marks . most cases of cushing’s syndrome , however , are caused by small pituitary tumors and are not treated by adrenal gland removal . overall , adrenal tumors account for about 20 % of cases of cushing’s syndrome .
an incidentally found mass in the adrenal may be any of the above types of tumors , or may produce no hormones at all . most incidentally found adrenal masses do not make excess hormones , cause no symptoms , are benign , and do not need to be removed . surgical removal of incidentally discovered adrenal tumors is indicated only if :