Retroperitoneoscopic adrenalectomy

Abstract

Adrenal glands are extraperitoneal organs situated almost in the center of the body. Classically, very invasive procedures have been necessary to manage adrenal disease. Endoscopic surgery can play an important role, avoiding large abdominal, lumbar, or thoraco-abdominal incisions. This is of particular importance because the majority of adrenal tumors is small in size and the specimens are readily extractable. Retroperitoneoscopic surgery originates from pneumoretroperitoneography, a radiological technique, used before the era of computed tomography (CT), based on the injection of air into the para-renal space to enhance the contrast between structures, thereby delineating renal and adrenal tumors. This is possible because the posterior aspect of Gerota’s capsule is easily separated from the posterior lumbar fascia as well as from the other fascias. Subsequently, retroperitoneoscopy allows performing diagnostic and operative procedures of kidneys, adrenal glands, renal pelvis, ureters, and great vessels.