V09-06: Posterior Retroperitoneoscopic Adrenalectomy: How and When
Transperitoneal laparoscopic adrenalectomy is the standard of care for most adrenal masses. However, posterior retroperitoneoscopic adrenalectomy (PRA) may be advantageous, particularly for patients with abdominal visceromegalies, multiples previous abdominal surgeries and bilateral adrenal lesions in which the repositioning is avoided. Relative contraindications are previous retroperitoneal surgeries and adrenal masses > 7cm. Advantages of PRA are shorter operative time, less blood loss, earlier oral intake and shorter hospitalization. The purpose of this video is to show the key steps of this technique.
The patient is placed in jack-knife position. The first 12mm trocar is placed below the tip of the 12th rib. Another 12mm trocar is placed lateral to the paraspinous muscle and a 5mm trocar is placed below the 11th rib in the posterior axillary line. When a pneumoperitoneum pressure of 20 mmHg of CO2 is achieved, the retroperitoneal working space is bluntly created. The gland is mobilized from the kidney and the inferior vena cava or abdominal aorta with harmonic. Finally, the adrenal vein is clipped and divided and the gland is removed.
12 PRA were performed up to now. Nine of them (75%) were functional lesions. Mean operative time: 104,3 minutes. Median hospital stay: 2 days. No major complications were registered. All patients achieved clinical and biochemical cure at mean follow up of 36 months .
PRA is a safe and effective technique, with short operative time and fast recovery but requires a thorough knowledge of retroperitoneal anatomy.