Left Partial Posterior Retroperitoneoscopic Adrenalectomy

  • Alexander ShifrinEmail author


The left posterior retroperitoneoscopic adrenalectomy is a less invasive technique for the removal of the adrenal gland as compared to the traditional left laparoscopic transabdominal method. This technique, known since the early 1990s, later was introduced to the surgical community by the world expert in this approach, Prof. Martin Walz from Essen, Germany. He has not only perfected this technique but also taught it to other surgeons throughout the world, revolutionizing the surgical management of adrenal tumors. The adrenal gland is approached without entering the peritoneum, which avoids colonic splenic flexure and spleen mobilization. Posterior retroperitoneoscopic approach is especially beneficial in patients with a history of prior abdominal surgeries. 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 as familiar to some surgeons due to a different anatomical orientation. The posterior approach can be used to perform bilateral adrenalectomies as well. The advantages of this approach are shorter operative time, less postoperative pain, 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 [1–8]. The posterior approach is recommended for benign adrenal tumors less than 6 cm. For bigger tumors, or any tumors suspicious for the adrenocortical carcinoma, the anterior or open approach should be considered.


Posterior retroperitoneoscopic adrenalectomy Adrenalectomy Laparoscopic adrenalectomy Adrenal surgery Primary hyperaldosteronism Conn’s syndrome Aldosteronoma Aldosteronism Adrenal gland surgery 

Supplementary material

Video 6.1a

Left partial posterior retroperitoneoscopic adrenalectomy (MP4 514046 kb)

Video 6.1b

Left partial posterior retroperitoneoscopic adrenalectomy (MP4 509351 kb)

Video 6.1c

Left partial posterior retroperitoneoscopic adrenalectomy (MP4 462585 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.Google 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, Gwosdz R, Levin SL, Alesina PF, Suttorp AC, Metz KA, et al. Retroperitoneoscopic adrenalectomy in Conn’s syndrome caused by adrenal adenomas or nodular hyperplasia. World J Surg. 2008;32(5):847–53.CrossRefGoogle Scholar
  7. 7.
    Chen SF, Chueh SC, Wang SM, Wu VC, Pu YS, Wu KD, et al. Clinical outcomes in patients undergoing laparoscopic adrenalectomy for unilateral aldosterone producing adenoma: partial versus total adrenalectomy. J Endourol. 2014;28(9):1103–6.CrossRefGoogle Scholar
  8. 8.
    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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