Right Posterior Retroperitoneoscopic Adrenalectomy

Abstract

The posterior retroperitoneoscopic adrenalectomy is a less invasive technique for the removal of the adrenal gland than the traditional laparoscopic transabdominal method. Known since the early 1990s, the technique was later introduced to the surgical community by Prof. Martin Walz of Essen, Germany. He perfected the technique and taught it to surgeons throughout the world, revolutionizing the surgical management of adrenal tumors. With posterior retroperitoneoscopic adrenalectomy, the adrenal glands are approached without entering the peritoneum, which avoids the following: (1) liver mobilization, dissection, and retraction on the right side and (2) colonic splenic flexure and spleen mobilization and retraction on the left side. Posterior retroperitoneoscopic approach is especially beneficial in patients with a history of prior abdominal surgeries (cholecystectomy, colon, or small bowel resection, etc.): the development of intraperitoneal adhesions will not influence the complexity of the posterior approach. The dissection is performed in the retroperitoneal space without entering the peritoneum. The posterior retroperitoneal approach however may not be familiar to some surgeons due to a different anatomical orientation. Advantages of this approach include shorter operative time, ability to perform bilateral adrenalectomy, ability to dissect the tumor located behind the vena cava, reduced postoperative pain for the patient, and quicker recovery. This approach has demonstrated excellent outcomes for nonfunctional and functional adrenal tumors, such as aldosteronoma (Conn’s syndrome), Cushing’s syndrome, and pheochromocytoma [1–6]. The usual cutoff size for the posterior approach is benign adrenal tumors smaller than 6 cm. For larger tumors or any suspicious of adrenocortical carcinoma, the anterior or open approach should be considered.