Right Posterior Retroperitoneoscopic Adrenalectomy

  • Alexander ShifrinEmail author


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.


Posterior retroperitoneoscopic adrenalectomy Adrenalectomy Laparoscopic adrenalectomy Adrenal surgery Adrenal gland surgery 

Supplementary material

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Right posterior retroperitoneoscopic adrenalectomy (MP4 608143 kb)

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Right posterior retroperitoneoscopic adrenalectomy (MP4 495484 kb)


  1. 1.
    Walz MK, Peitgen K, Hoermann R, Giebler RM, Mann K, Eigler FW. Posterior retroperitoneoscopy as a new minimally invasive approach for adrenalectomy: results of 30 adrenalectomies in 27 patients. World J Surg. 1996;20(7):769–74.CrossRefGoogle Scholar
  2. 2.
    Walz MK, Alesina PF, Wenger FA, Deligiannis A, Szuczik E, Petersenn S, et al. Posterior retroperitoneoscopic adrenalectomy—results of 560 procedures in 520 patients. Surgery. 2006;140(6):943–8. discussion 948–50.CrossRefGoogle Scholar
  3. 3.
    Dickson PV, Jimenez C, Chisholm GB, Kennamer DL, Ng C, Grubbs EG, et al. Posterior retroperitoneoscopic adrenalectomy: a contemporary American experience. J Am Coll Surg. 2011;212(4):659–65. discussion 665–7.CrossRefGoogle Scholar
  4. 4.
    Lee CR, Walz MK, Park S, Park JH, Jeong JS, Lee SH, et al. A comparative study of the transperitoneal and posterior retroperitoneal approaches for laparoscopic adrenalectomy for adrenal tumors. Ann Surg Oncol. 2012;19(8):2629–34.CrossRefGoogle Scholar
  5. 5.
    Kiriakopoulos A, Economopoulos KP, Poulios E, Linos D. Impact of posterior retroperitoneoscopic adrenalectomy in a tertiary care center: a paradigm shift. Surg Endosc. 2011;25(11):3584–9.CrossRefGoogle Scholar
  6. 6.
    Walz MK. Posterior retroperitoneoscopic adrenalectomy. In: Linos DA, Van Heerden JA, editors. Adrenal glands: diagnostic aspects and surgical therapy. Heidelberg: Springer; 2011. p. 333–9.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of SurgeryJersey Shore University Medical CenterNeptuneUSA

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