Abstract
Posterior retroperitonoscopic adrenalectomy (PRA) has become a standard approach to the adrenal gland. The aim of this study was to report an initial experience with the procedure following a proper preparatory phase highlighting the rapidity, safety and effectiveness by which it could be introduced into a surgeon’s practice. Between May 2015 and July 2016, 14 PRAs were performed in 14 patients (9 females and 5 males). The average age was 46 years, BMI: 25.5 kg/m2, and ASA score: 2. Indications included: incidenatloma (n = 5), Conn’s adenoma (n = 5), and Cushing’s adenoma (n = 4). Lesions were on average 3.3 cm in size. Outcomes of interest included: operative time (OT), conversion rate, postoperative morbidity and mortality rates, and the length of hospital stay. Mean OT was 87.5 min (range 35–150 min). A significant reduction in OT occurred after the sixth procedure and was progressive thereafter. After the tenth case, the OT became less than 1 h. No conversion was required. No intra- or post-operative complications occurred, and mortality was zero. All patients commenced oral intake and ambulated following full recovery from anesthesia. The mean length of hospital stay was 3 days (range 2–6 days). PRA offers a direct access to the adrenal gland allowing for target-oriented dissection. Cognitive reorientation to the anatomy of this back door access and an adequate learning curve could be rapidly achieved by experienced and properly prepared laparoscopic surgeons.
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Acknowledgements
The authors thank Dr Walz for his devotion to evidence-based surgical innovation, and for sharing his time and experience mentoring the procedure. Dr Marco Biricotti’s work in preparing the video is also highly appreciated.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This work was approved by the Ethics Committee at the University Hospital of Pisa, Pisa-Italy.
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Bakkar, S., Materazzi, G., Fregoli, L. et al. Posterior retroperitonoscopic adrenalectomy; a back door access with an unusually rapid learning curve. Updates Surg 69, 235–239 (2017). https://doi.org/10.1007/s13304-017-0437-9
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DOI: https://doi.org/10.1007/s13304-017-0437-9