After performing the first cases in Coimbra some years ago, I adopted the Posterior Retroperitoneoscopic approach as the gold standard for adrenal surgery. Transperitoneal adrenalectomy is the most frequently used throughout the world because surgeons are afraid to change from the peritoneal space to an unfamiliar retroperitoneal working space. Additionally, many are unable to change from an anterior anatomical perspective to a posterior perspective. However, posterior retroperitoneoscopic adrenalectomy, a “back door” approach, has several advantages for both patients and doctors.
In that setting, the Department of Urology of the Jose R. Reys Memorial Medical Center from Manilla, Philippines, invited me to give a lecture about Posterior Retroperitoneoscopic Adrenalectomy during the “50th Post Graduate Course – Beyond Limits: Exploring New Frontiers”. Thank you to Dr. Rufino Agudera (Chairman) and Dr. Enrique Lorenzo (Training Officer) for the invitation. Congratulations to the entire department for the outstanding organization and its 50th anniversary.
Being a department with great experience in laparoscopic surgery (performing mostly the transperitoneal approach), they showed interest in knowing more about this technique, its indications, advantages, outcomes, and reasons to change. Dr. Rajiv Kalbit moderated the Q&A discussion wisely.
The take-home messages of the lecture were clear and appreciated, I believe.
There are several advantages of posterior retroperitoneoscopic adrenalectomy over the transperitoneal approach, namely:
Easier to ventilate the patient.
Less hemodynamic disturbances and more cardiovascular stability.
Bilateral surgery without changing positioning.
Direct access to the gland.
No need to mobilize other organs.
No risk of injuries to abdominal viscera.
Avoid adhesions in patients with previous abdominal surgeries.
Less blood loss.
Less postoperative pain.
Faster operative time.
Shorter time to first oral intake and ambulation.
Faster recovery no normal activity.
Better cosmesis and no incisional hernias.
Complications are rare, usually minor, and temporary. Mortality has been consistently reported as zero.
A surgeon who wants to start performing posterior retroperitoneoscopic adrenalectomy should first assist an expert in some cases to learn the tricks and tips; and second, if possible, should have the expert by his/her side while performing the first cases.
A shorter learning curve is possible if a surgeon already has experience in other laparoscopic surgeries.
I leave you with a slide I presented with a table resuming all the indications, advantages, and potential problems of the posterior retroperitoneal approach for adrenal tumors. I believe there is no reason for this technique to be part of a surgeon's armamentarium since it has many advantages for patients. Do not fight against it, just learn how to do it.
Once again, congratulations to the great team from the Department of Urology of the José R. Reys Memorial Medical Center in Manilla, Philippines. You are really on top of it. Hope to meet you all again in the future.
Do you want to learn about Posterior Retroperitoneoscopic Adrenalectomy?
Costa Almeida CE, editor. Posterior Retroperitoneoscopic Adrenalectomy. Indications, Technical Steps and Outcomes. Switzerland: Springer; 2023.
Dr. Carlos Eduardo Costa Almeida
General Surgeon
#adrenal #adrenalectomy #retroperitoneal #retroperitoneum #retroperitoneoscopic #posterior_retroperitoneoscopic_adrenalectomy #conn #pheochromocytoma #cushing #carcinoma
Comments