Comparison of laparoscopic transabdominal lateral versus posterior retroperitoneal adrenalectomy

Robotic Posterior Retroperitoneal Adrenalectomy

“…Although the mean operating time of this series is longer than we reported in our 100 laparoscopic posterior adrenalectomy cases, 5 we believe that this might be owing to both our learning curve and to selection of harder cases for the posterior approach owing to the advantages of robotic instrumentation.…”

“…[3][4][5][6] The PR technique provides direct access to the adrenal gland without mobilization of the liver or spleen and has been used in favor of the lateral technique for bilateral tumors and in patients with a history of extensive abdominal procedures. 5 In 2000 we described a modification of the Mercan technique 2 with the addition of laparoscopic ultrasound (US). 7 Despite ease of access to the adrenal gland, there are limitations of the PR technique owing to the small working space, close positioning of the ports, and lack of angulation of the rigid laparoscopic instruments.…”

Changing Surgical Approaches for Laparoscopic Adrenalectomy: Single-Surgeon Data of a 6-Year Experience

“…In group 2, retroperitoneal LA was performedaccording to Sung et al [7], retroperitoneal LA in prone position according to Berber et al [8] and retroperitoneal LESS for adrenalectomy according to Ryu et al [9]. …”

Laparoscopic Adrenalectomy: Where Do We Stand Now?

“…The superior pole of the gland is dissected and the left adrenal arteries are clipped and divided. The dissection of the adrenal from the kidney then proceeds and the removal of the specimen, hemostasis, and drainage of the operative area and closure of the port sites is similar to the procedure for the right adrenalectomy (Gagner et al 1997;Jacobs et al 1997;Yoneda et al 2000;Suzuki et al 2001;Ramacciato et al 2008;Toniato et al 2007;Humphrey et al 2008;Berber et al 2009). …”

“…A laparoscope is inserted into the balloon trocar to visualize the retroperitoneal space and then the balloon trocar is replaced by a standard 10 mm trocar. After the development of an adequate retroperitoneal working space by insufflation of CO 2 at 12-20 mmHg pressure, the other trocars are inserted under direct vision, as follows: below the edge of the twelfth rib, lateral to the eleventh rib and the last trocar is introduced between the ninth and tenth rib (Yoneda et al 2000;Sung et al 2001;Walz et al 2006;Berber et al 2009). An atraumatic retractor is introduced through the inferior trocar to retract the kidney downwards.…”