Left Partial Posterior Retroperitoneoscopic Adrenalectomy

Abstract

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.