Posterior retroperitoneoscopic adrenalectomy: preferred technique for removal of benign tumors and isolated metastases.

Abstract:

OBJECTIVE:Posterior retroperitoneoscopic adrenalectomy (PRA) is a minimally invasive approach to removal of the adrenal gland. This anatomically direct approach, popularized by Walz, minimizes dissection and affords early access to the adrenal vein. We report the largest experience to date of PRA in the United States. METHODS:The prospective endocrine surgery database at a tertiary care center was used to capture all patients who underwent PRA between October 2005 and February 2008. All PRA procedures were performed using a 3-trocar technique with the patient in a prone jackknife position. RESULTS:Sixty-eight PRAs were performed in 62 patients; there were 6 conversions (3 video-assisted and 3 open). Indications for adrenalectomy were functional tumors in 43 patients (20 pheochromocytomas, 13 Cushing disease or syndrome, and 10 others), nonfunctional cortical adenomas in 4, and isolated adrenal metastases in 15. Mean tumor size was 3.4 cm. Complications occurred in 11 patients (16%), with no perioperative deaths. In 34 (55%) patients, there was a relative contraindication to an anterior approach. Additionally, 20 patients (38%) had a body mass index greater than 30. Median operating time was 121 minutes. CONCLUSION:PRA is safe, avoids intra-abdominal adjacent organ mobilization, is unaffected by the presence of intra-abdominal adhesions, and is possible in obese patients. PRA may be the preferred technique for removing benign adrenal tumors and isolated metastases.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Perrier ND,Kennamer DL,Bao R,Jimenez C,Grubbs EG,Lee JE,Evans DB

doi

10.1097/SLA.0b013e31818a1d2a

subject

Has Abstract

pub_date

2008-10-01 00:00:00

pages

666-74

issue

4

eissn

0003-4932

issn

1528-1140

pii

00000658-200810000-00020

journal_volume

248

pub_type

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