Since 2015 I am using posterior retroperitoneoscopic adrenalectomy to treat adrenal tumors up to 6-8 cm without malignant features. It is a fast learning technique if the surgeon has already gained laparoscopic experience from other procedures (colorectal laparoscopic surgery, hepatobiliary surgery, laparoscopic hernia repair). It has known advantages over the transperitoneal approach: direct access to the adrenal, avoidance of intraperitoneal organs, faster to perform (our mean operative time is 39 min), minimal postoperative pain, and fast recovery.
Left adrenal has a position that makes it harder to dissect since it covers the front surface of the kidney, meaning more mobilization of the kidney is necessary. The right adrenal has a more favorable position, but in right side you will find the “big blue” adjacent to the gland. I am talking about the inferior vena cava, which gives the surgeon more stress due to the risk of vascular lesion. Another important point on the right side is the anatomic variation of the hepatic veins. Great attention must be given during operation to avoid lesion. Remember that an accessory inferior right hepatic vein is present in about 48% of patients. Additionally, the right adrenal vein is usually small and located high in the operation field. Using the posterior retroperitoneoscopic approach the right adrenal vein will be in front of the gland.
To see some of these difficulties and to imagine the stress of dissecting near the inferior vena cava, I am presenting this new video of a right-sided Conn’s Syndrome treated with posterior retroperitoneoscopic adrenalectomy. Operation took 30 min, and there were no complications. In the day after the patient was discharged home.
Enjoy!
Links to video:
Follow the link if you want to read about our first results:
Dr. Carlos Eduardo Costa Almeida
General Surgeon
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