Posterior Retroperitoneoscopic Adrenalectomy: Indications, Technical Steps and Outcomes

Preface
Contents
Contributors
Abbreviations
1: Anatomy of the Adrenal Gland
	1.1	 Introduction
	1.2	 The Adrenal Gland
		1.2.1	 Anatomical Landmarks and Topographic Anatomy
		1.2.2	 Arterial Supply
		1.2.3	 Venous Drainage
		1.2.4	 Lymphatic Drainage
		1.2.5	 Innervation
	1.3	 Anatomical Considerations in Posterior Retroperitoneoscopic Adrenalectomy
		1.3.1	 Retroperitoneum
		1.3.2	 Abdominal Wall (Posterior and Anterolateral)
	References
2: Indications for Adrenalectomy
	2.1	 Introduction
	2.2	 Posterior Retroperitoneoscopic Adrenalectomy in Overproduction Adrenal Syndromes
		2.2.1	 Excessive Production of Aldosterone: Hyperaldosteronism
		2.2.2	 Excessive Production of Glucocorticoids: Cushing’s Syndrome
		2.2.3	 Excessive Production of Catecholamines: Pheochromocytoma and Paraganglioma
	2.3	 Posterior Retroperitoneoscopic Adrenalectomy in Adrenal Malignancies
		2.3.1	 Adrenocortical Carcinoma
		2.3.2	 Malignant Pheochromocytoma and Paraganglioma
		2.3.3	 Metastases to the Adrenal Glands
	2.4	 Adrenal Incidentaloma
	2.5	 Partial Adrenalectomy
	References
3: Open Versus Minimally Invasive Approach
	3.1	 Introduction
	3.2	 Validation of Laparoscopic Adrenal Surgery
	3.3	Still a Place for Open
	3.4	 Open Surgery
		3.4.1	 Current Indications
		3.4.2	 Risk of Conversion to Open
	3.5	 Open Technique
		3.5.1	 Anterior Approach
			3.5.1.1	 Technique for the Right Side
			3.5.1.2	 Technique for the Left Side
		3.5.2	 Posterior Approach
		3.5.3	 Thoracoabdominal Approach
	3.6	 Conclusion
	References
4: Retroperitoneoscopic Versus Laparoscopic Adrenalectomy
	4.1	 Background and Clinical Considerations
	4.2	 Intraoperative Outcomes
	4.3	 Postoperative Outcomes
	References
5: Retroperitoneoscopic Approach in Malignant Disease
	5.1	 Introduction
	5.2	 Preoperative Evaluation of Patients with Adrenal Lesions Suspicious for Malignancy
	5.3	 Minimally Invasive Adrenal Surgery for Indeterminate Adrenal Nodules Suspicious for Malignancy
	5.4	 Minimally Invasive Adrenal Surgery for Metastatic Disease
	5.5	 Minimally Invasive Adrenal Surgery for Adrenocortical Carcinoma
	References
6: Anesthesia in Posterior Retroperitoneoscopic Approach
	6.1	 Introduction
	6.2	 Preoperative Patient Evaluation
	6.3	 Anesthesia for PRA
	6.4	 Postoperative Pain Management
	References
7: Technical Steps of Posterior Retroperitoneoscopic Adrenalectomy
	7.1	 Introduction
	7.2	 Surgical Instruments and Operation Table Setup
	7.3	 Surgical Team
	7.4	 Step-by-Step
		7.4.1	 Positioning the Patient
		7.4.2	 Placing the First Trocars (Balloon Trocar and Lateral Trocar)
		7.4.3	 Creating the Working Space
		7.4.4	 Placing the Third Trocar (Medial Trocar)
		7.4.5	 Finding Upper Pole of the Kidney
		7.4.6	 Finding the Inferior Vena Cava (IVC)
		7.4.7	 Dissecting and Ligating the Adrenal Vein
		7.4.8	 Dissecting the Entire Gland
		7.4.9	 Retrieving with an Extraction Bag
		7.4.10	 Final Check (Hemostasis) and Closure
	7.5	 Tips and Tricks
	7.6	 Video of Posterior Retroperitoneoscopic Adrenalectomy
	7.7	 Postoperative Care
	7.8	 Final Notes
	References
8: Intraoperative Complications
	8.1	 Introduction
	8.2	 Vascular Injury, Hemorrhage, and Cardiovascular Complications
	8.3	 Retroperitoneal Fatty Tissue
	8.4	 Injuries of the Intestine
	8.5	 Injuries to Other Organs
	8.6	 Abdominal Wall Relaxation and Hypoesthesia
	8.7	 Pleural Lesions
	8.8	 Misplacement of Trocars
	8.9	 Rare Complications
	8.10	 Risk Factors for Intraoperative Complications
	8.11	 Laparoscopic Versus Retroperitoneoscopic Adrenalectomy
	References
9: Management of Vascular Injuries (IVC)
	9.1	 Introduction
	9.2	 The Major Vascular Complication
	9.3	 Surgical Team and Operation Room Staff Preparation
	9.4	 Vascular Injury Repair
		9.4.1	 How to Do It?
	9.5	 Vascular Injuries and Learning Curve
	9.6	 Case Report
	References
10: Converting to Open Surgery
	10.1	 Introduction
	10.2	 Definition of Conversion to Open Surgery
	10.3	 Risk Factors Associated with Conversion to Open Surgery during Transperitoneal Laparoscopic Adrenalectomy
		10.3.1	 Obesity
		10.3.2	 Size of the Tumor
		10.3.3	 Pheochromocytoma
	10.4	 How to Convert?
		10.4.1	 Choice of Incision
		10.4.2	 Open Right Adrenalectomy
		10.4.3	 Open Left Adrenalectomy
	10.5	 Concluding Remarks
	References
11: Final Outcomes
	11.1	 Introduction
	11.2	 Operative Time
	11.3	 Complication Rate and Mortality
	11.4	 Conversion Rate and Blood Loss
	11.5	 Postoperative Pain
	11.6	 In-Hospital Days and Recovery to Normal Activity
	11.7	 Learning Curve
	11.8	 Final Notes
	References
12: Robotic Surgery and Innovation
	12.1	 Introduction
	12.2	 Surgical Technique of Robotic Posterior Retroperitoneal Adrenalectomy
	12.3	 Preoperative Preparation and Setup of the Patient
	12.4	 Evidence Regarding Robotic Posterior Retroperitoneal Adrenalectomy
		12.4.1	 Case Series
		12.4.2	 Laparoscopic Versus Robotic Posterior Retroperitoneal Adrenalectomy
		12.4.3	 Robotic Posterior Retroperitoneal Adrenalectomy Versus Transabdominal Lateral Robotic Adrenalectomy
		12.4.4	 Cost Analysis
	References