The technique of posterior retroperitoneoscopic adrenalectomy

Background. Laparoscopic adrenalectomy represents the new gold standard of adrenal surgery. While the retroperitonescopic approach provides a more direct access to the adrenal gland, its use is still limited with respect to the transabdominal approach. Purpose. After a long experience performing laparoscopic adrenalectomy by means of a lateral transperitoneal approach, the Authors have recently begun using a posterior retroperitoneoscopic approach for this procedure. In their report the Authors analyze the results obtained with the new technique. Methods. The technique of retroperitoneoscopic adrenalectomy is described and the results regarding a meta-analysis of studies reported in the international literature are presented. Results. To date more than 1000 cases treated by the retroperitoneoscopic adrenalectomy have been described in the literature. The studies reported uniformely demonstrate the safety and effectiveness of the posterior approach in both unilateral and bilateral procedures. Mean operating times (range: 35-531 minutes) and rates of conversion in the various series (0-4.5%) were extremely variable and strongly linked to individual surgica experience. Postoperative pain, lenght of hospital stay and postoperative recovery proved comparable to those of lateral transperitoneal adrenalectomy. Conclusions. Although technically more demanding, posterior retroperitoneoscopic adrenalectomy is a valid option for treating patients with small benign lesions (< 6 cm) or bilateral lesions as well as patients with a history of prior abdominal surgery and patients who are obese.