Posterior retroperitonoscopic adrenalectomy; a back door access with an unusually rapid learning curve

Abstract

Posterior retroperitonoscopic adrenalectomy (PRA) has become a standard approach to the adrenal gland. The aim of this study was to report an initial experience with the procedure following a proper preparatory phase highlighting the rapidity, safety and effectiveness by which it could be introduced into a surgeon's practice. Between May 2015 and July 2016, 14 PRAs were performed in 14 patients (9 females and 5 males). The average age was 46 years, BMI: 25.5 kg/m, and ASA score: 2. Indications included: incidenatloma (n = 5), Conn's adenoma (n = 5), and Cushing's adenoma (n = 4). Lesions were on average 3.3 cm in size. Outcomes of interest included: operative time (OT), conversion rate, postoperative morbidity and mortality rates, and the length of hospital stay. Mean OT was 87.5 min (range 35-150 min). A significant reduction in OT occurred after the sixth procedure and was progressive thereafter. After the tenth case, the OT became less than 1 h. No conversion was required. No intra- or post-operative complications occurred, and mortality was zero. All patients commenced oral intake and ambulated following full recovery from anesthesia. The mean length of hospital stay was 3 days (range 2-6 days). PRA offers a direct access to the adrenal gland allowing for target-oriented dissection. Cognitive reorientation to the anatomy of this back door access and an adequate learning curve could be rapidly achieved by experienced and properly prepared laparoscopic surgeons.

A case of adrenocortical carcinoma accompanying secondary acute adrenal hypofunction postoperation

“…Bacalbasa et al [ 11 ] reported the case of a 65-year-old patient treated with a complete resection en bloc with left nephrectomy and adrenalectomy, distal pancreatectomy, splenectomy, left colectomy, and para-aortic lymph node dissection. In the modern pursuit of minimally invasive technology with respect to aesthetics, posterior retroperitonoscopic adrenalectomy (PRA) has become a standard approach for removal of the adrenal gland [ 12 ].…”

Challenges of training in adrenal surgery

“…For retroperitoneoscopic approach, the pressure is usually set at 18-25 mmHg to provide a sufficient operating space. Despite this, the retroperitoneoscopic approach has been reported to have a rapid learning curve (37).…”