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Review
. 2019 Jul;8(Suppl 1):S36-S40.
doi: 10.21037/gs.2019.03.11.

Retroperitoneal adrenalectomy-learning curve, practical tips and tricks, what limits its wider uptake

Pier Francesco Alesina  1
Affiliations
Review

Retroperitoneal adrenalectomy-learning curve, practical tips and tricks, what limits its wider uptake

Pier Francesco Alesina. Gland Surg. 2019 Jul.

Abstract

The minimally invasive retroperitoneal approach to the adrenal surgery has been described in the early 90s following the first description of laparoscopic adrenalectomy. Although the advantages of the technique compared to laparoscopic surgery have been demonstrated in many studies, it remained for a long period confined to few centers. The operation has been standardized over the years into a safe and reproducible procedure that finally gained worldwide acceptance in the last 10 years. The present paper summarizes the surgical steps of the procedure focusing on the recent technical developments. Retroperitoneoscopic adrenalectomy should be part of the surgical armamentarium of any center dedicated to endocrine surgery.

Keywords: Adrenalectomy; laparoscopic adrenalectomy; minimally invasive adrenalectomy; retroperitoneoscopic adrenalectomy.

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Conflict of interest statement

Conflicts of Interest: The author has no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Position of the patient.
Figure 2
Figure 2
Trocar position: a blunt trocar with an inflatable balloon and an adjustable sleeve is introduced into the initial incision, a 5 mm trocar for the working instruments is used at the tip of the 11th rip and a 10 mm trocar is placed medially between spine and first incision.
Figure 3
Figure 3
Right side: the dissection of the lower pol of the adrenal gland is started from lateral to medial, the vena cava is already visualized and partially dissected.
Figure 4
Figure 4
The kidney on the left side is widely mobilized to reach the lower pol of the adrenal gland generally located behind the kidney.
Figure 5
Figure 5
The vena cava is visualized medially to the lower pole of the adrenal gland.
Figure 6
Figure 6
The left adrenal vein and inferior diaphragmatic vein are isolated.
Figure 7
Figure 7
The adrenal gland is retracted laterally and the right adrenal vein is isolated; in this case two accessory hepatic veins are visible below the main adrenal vein.
See this image and copyright information in PMC

References

    1. Higashihara E, Tanaka Y, Horie S, et al. A case report of laparoscopic adrenalectomy. Nihon Hinyokika Gakkai Zasshi 1992;83:1130-3. 10.5980/jpnjurol1989.83.1130 - DOI - PubMed
    1. Gagner M, Lacroix A, Bolte E. Laparoscopic adrenalectomy in Cushing's syndrome and pheochromocytoma. N Engl J Med 1992;327:1033. 10.1056/NEJM199210013271417 - DOI - PubMed
    1. Gaur DD. Laparoscopic operative retroperitoneoscopy: use of a new device. J Urol 1992;148:1137-9. 10.1016/S0022-5347(17)36842-8 - DOI - PubMed
    1. Brunt LM, Molmenti EP, Kerbl K, et al. Retroperitoneal endoscopic adrenalectomy: an experimental study. Surg Laparosc Endosc 1993;3:300-6. - PubMed
    1. Uchida M, Imaide Y, Yoneda K, et al. Endoscopic adrenalectomy by retroperitoneal approach for primary aldosteronism. Hinyokika Kiyo 1994;40:43-6. - PubMed