Technical aspects of retroperitoneoscopic adrenalectomy by a posterior lumbar approach

Most of recent reports on retroperitoneoscopic adrenalectomy have described an extraperitoneal flank approach. The aim of this paper is to describe the feasibility of a posterior approach for retroperitoneoscopic adrenalectomy. Patients and Methods; Fifteen patients (8 men and 7 women) with adrenal tumors (5 Cushing's syndrome, 7 Aldosteronomas, 1 pheochromocytoma, 1 myelolipoma, 1 virilizing adenoma) underwent retroperitoneoscopic adrenalectomy by a posterior lumbar approach (RPA). The age of the patients was 45 ± 11 years old, and the tumor diameter averaged 28 mm. The patient was placed in a prone position, flexing the spine to open out the relevant posteior lumbar area between the 12th rib and iliac crest. The first port was made 3cm below the tip of the 12th rib by making a small skin incision. After creation of a space by balloon dissection outside the Gerota's fascia, two 12-mm trocars were inserted below the 12th rib(one trocar was inserted 3cm medial to the first port, and the other on the posterior axillary line) using an Optiview trocar and laparoscope. Results: With this posterior approach, the renal artery with it's adrenal branches were easily recognized in all patients. RPA allowed direct access to the large abdominal vessel and main adrenal vassels before the gland was greatly manipulated. The adrenal was evacuated via a skin incision made for the first port The adrenalectomy was accomplished within remarkably short operating time(163 ± 42 minutes). The procedure, however, had to be converted to open surgery in one patient who developed tension pneumothorax due to diaphragmatic injury during dissection. All the other patients were ambulated on the first postoperative day. In summary, RPA was technically feasible and most effective for retroperitoneoscopic adrenalectomy as regard to the simplicity of vascular control. The operating time, perioperative morbidity and cost were reduced with this approach.