After learning in 2014 posterior retroperitoneoscopic adrenalectomy (PRA) from Prof Martin Walz in Essen, Germany, I started performing it with enthusiasm. This is the best way to treat adrenal tumors up to 6-8 cm compared to other surgical approaches. PRA is faster to perform, has fewer complications and less pain, and promotes a faster recovery. Patients do benefit from this approach. However, many surgeons resist this technique because they are not used to the posterior retroperitoneal anatomical perspective.
During the 57th Annual Congress of the Egyptian Urological Association (EUA) and in cooperation with the European Association of Urology Section of Uro-Technology (ESUT), I was invited by Prof Ali Gözen to share my knowledge on PRA. In a non-edited video during a live session, I presented the technique and showed the audience how easy it is to enter the perirenal space from behind, demonstrated the advantage of direct access to the adrenal, showed how feasible, safe, and fast it is to remove a pheochromocytoma with 5 cm. The cosmesis advantage is evident: "The patient can only see the scars with a mirror". Since we do not enter the peritoneal space, the risk of injury to the abdominal viscera is almost null, and pain is minimal.
Thank you to Prof Ali Gözen (ESUT) and Prof Hassan Abol-Enei (EUA) for the invitation. Congratulations on the outstanding organization of the EUA/ESUT Live Surgery Session in Cairo, Egypt. Also, thank you to the Egyptian Urological Association (EUA) and the European Association of Urology Section of Uro-Technology (ESUT) for promoting different approaches and ideas. This is the only way to innovate and offer our patients the best-tailored treatment.
I will keep using and promoting posterior retroperitoneoscopic adrenalectomy (PRA) since I believe this should be the gold standard of care for most adrenal tumors with surgical indications. In that setting, I am available to receive any patient you may have with a benign functional adrenal tumor up to 6 cm (Conn Syndrome, Cushing Syndrome, Pheochromocytoma).
Let’s work together to offer our patients the best treatment.
Costa Almeida CE, editor. Posterior Retroperitoneoscopic Adrenalectomy. Indications, Technical Steps and Outcomes. Switzerland: Springer; 2023.
Dr. Carlos Eduardo Costa Almeida
General Surgeon
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