Posterior Retroperitonoscopic Adrenalectomy; How to Do it - Pearls and Secrets

Since the early 1990s, endoscopic adrenalectomy has become the gold standard surgical approach for the adrenal gland. Also, lateral transperitoneal adrenalectomy (LTA) which is the most widely used approach accompanies that. Posterior retroperitonoscopic adrenalectomy (PRA) is another safe and effective approach for the adrenal gland. However, it has not gained global popularity. This is largely attributed to the unfamiliarity of surgeons with the ergonomics and executional steps of the procedure, and the relevant retroperitoneal anatomy. Misconceptions held by both surgeons and anesthesiologists regarding the consequences of the high-pressure retroperitoneal insufflation required may also be a contributing factor. The aim of this article is to provide a detailed description of PRA in a manner which allows the proper acquisition of the knowledge required to perform the procedure safely and effectively.
To achieve the objective of this article, it has been broadly divided into three sections including background, operative technique, and comments. The background provides an introduction to the procedure and its advantages. The section about operative technique provides a detailed description of the preoperative preparatory phase, the proper access, and the executional steps of the procedures supplemented with illustrative figures. It also provides insight into potential hazards related to the anatomy of the adrenal veins, and the means of dealing with variant anatomy. The comments’ section deals with the procedure’s learning curve, and the factors affecting it. It also describes the ideal case for the commencement of the learning curve. A clarification of the misconceptions surrounding PRA is also provided in this section.
With thorough technical knowledge and an adequate learning curve, PRA could serve as the surgeon’s preferred surgical approach to the adrenal gland within the confines of its selection criteria.