In April 2014 I performed in Coimbra my first posterior retroperitoneoscopic (PR) adrenalectomy, it was for a Conn's syndrome. Since then, this approach became the gold standard of care for adrenal masses up to 6-8 cm in the Surgery C Department of Centro Hospitalar e Universitário de Coimbra, in Coimbra, Portugal.
After the first 10 patients submitted to posterior retroperitoneoscopic adrenalectomy by the same surgeon (the author), I decided to compare our results with those from other more experienced surgeons. The objective was to analyse the feasibility and morbidity of this technique.
I am now pleased to have these results published in International Journal of Surgery Case Reports. The title: "Posterior retroperitoneoscopic adrenalectomy - Case series."
We treated patients with adrenal masses from 1,8 cm to 14,0 cm (mean of 4,1 cm), including three cases of pheochromocytoma (one giant cystic pheochromocytoma with 14 cm). Mean operation time for posterior retroperitoneoscopic adrenalectomy was 46,7 min (worldwide reports from 40 to 105,6 min). Most of the patients were discharge home in the day after surgery, except for pheochromocytoma patients (mean post-operative in-hospital days of 2,2 days). No morbidity and no mortality. Only one case of conversion into laparotomy due to past clinical history of lumbar trauma. These results are similar to results published by more experienced surgeons worldwide (see table 2 of article).
Our mean operation time for posterior retroperitoneoscopic adrenalectomy was 46,7 min. No morbidity and no mortality.
PR adrenalectomy has advantages over the transperitoneal laparoscopic technique. However, the majority of surgeons with experience in laparoscopy feel safer and more confident when working in the traditional peritoneal space, and because of that they are renitent to use the PR approach. With this publication we can conclude that this technique has a small learning curve and is feasible if laparoscopic experience has been gained.
I believe this should be the gold standard technique to treat adrenal masses up to 6-8cm. Must find better excuses than small working space or hard to perform to justify not using it...
Link to article:
Dr. Carlos Eduardo Costa Almeida
General Surgeon