LAPAROSCOPIC RETROPERITONEAL ADRE-NALECTOMY BY POSTERIOR PRONE POSITION APPROACH: INICIAL ACHIEVEMENTS

Introduction: The first laparoscopic retroperitoneal adrenalectomy was proceed by Gagne, in 1992, and quickly became a popular technique and "The Gold Standard" regarding the classics advantages related to the laparoscopic access. The retroperitoneoscopic approach is a modern and not widespread way in our routine. The tchnique's standardization was due mainly by former works of Waltz (1996), which demonstrated the feasibility of pneumodissection in this approach. Objectives: the present study is a 3 cases report of laparoscopic retroperitoneal adrenalectomy by posterior prone position approach and a critic review of the literature. Methods: after the familiarization of the technique by the surgical oncology team, 3 cases was selected. One patient with single melanoma metastasis in right adrenal, one patient with metachronic metastasis of colonic cancer in right adrenal and one patient with pheochromocytoma in left adrenal. The duration of surgery lasted between 90 and 120 minutes. There was no significant bleeding in post-operative period. The pain was easily controlled with analgesics (simple and opiods). All three patients was discharged from hospital one day after the surgery. The literatures review shows that the technique is modern and not widespread. Also, presents some advantages: low morbidity, less pain and quick post-operation recovery. The biggest obstacle for the popularization of the technique has been the unfamiliar way of approach: the retroperitoneum, wich is well known by the urologists, but not a routine for general and oncology surgeons. Therefore, the technique requires specific learning curve. Conclusion: The laparoscopic retroperitoneal adrenalectomy by posterior prone position is an excellent approach for the small pathologies of the adrenal gland. Although it is not a popular way of access and it demands of familiarity, this approach is achiving space as a minimally invasive alternative, with benefits compared with the usual laparoscopic way.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019