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Feciche BO, Barbos V, Big A, Porav-Hodade D, Cumpanas AA, Latcu SC, Zara F, Barb AC, Dumitru CS, Cut TG, Ismail H, Novacescu D. Posterior Retroperitoneal Laparoscopic Adrenalectomy: An Anatomical Essay and Surgical Update. Cancers (Basel) 2024; 16:3841. [PMID: 39594796 PMCID: PMC11593218 DOI: 10.3390/cancers16223841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 11/09/2024] [Accepted: 11/11/2024] [Indexed: 11/28/2024] Open
Abstract
Posterior retroperitoneal laparoscopic adrenalectomy (PRLA) has emerged as a revolutionary, minimally invasive technique for adrenal gland surgery, offering significant advantages over traditional open approaches. This narrative review aims to provide a comprehensive update on PRLA, focusing on its anatomical foundations, surgical technique, and clinical implications. We conducted an extensive review of the current literature and surgical practices to elucidate the key aspects of PRLA. The procedure leverages a unique "backdoor" approach, accessing the adrenal glands through the retroperitoneum, which necessitates a thorough understanding of the posterior abdominal wall and retroperitoneal anatomy. Proper patient selection, meticulous surgical planning, and adherence to key technical principles are paramount for successful outcomes. In this paper, the surgical technique is described step by step, emphasizing critical aspects such as patient positioning, trocar placement, and adrenal dissection. PRLA demonstrates reduced postoperative pain, shorter hospital stays, and faster recovery times compared to open surgery, while maintaining comparable oncological outcomes for appropriately selected cases. However, the technique presents unique challenges, including a confined working space and the need for surgeons to adapt to a posterior anatomical perspective. We conclude that PRLA, in the right clinical setting, offers a safe and effective alternative to traditional adrenalectomy approaches. Future research should focus on expanding indications and refining techniques to further improve patient outcomes.
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Affiliation(s)
- Bogdan Ovidiu Feciche
- Department of Surgical Disciplines, Discipline of Urology, Faculty of Medicine and Pharmacy, University of Oradea, University Street, No. 1, 410087 Oradea, Romania;
- Department of Urology, Emergency County Hospital Oradea, Gheorghe Doja Street, No. 65, 410169 Oradea, Romania;
| | - Vlad Barbos
- Department of Urology, Emergency County Hospital Oradea, Gheorghe Doja Street, No. 65, 410169 Oradea, Romania;
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania;
| | - Alexandru Big
- Department of Urology, Emergency County Hospital Oradea, Gheorghe Doja Street, No. 65, 410169 Oradea, Romania;
| | - Daniel Porav-Hodade
- Department of Urology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu-Mures, Gh. Marinescu Street, No. 38, 540142 Targu-Mures, Romania;
| | - Alin Adrian Cumpanas
- Department XV, Discipline of Urology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania;
| | - Silviu Constantin Latcu
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania;
- Department XV, Discipline of Urology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania;
| | - Flavia Zara
- Department II of Microscopic Morphology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania; (F.Z.); (A.C.B.); (C.-S.D.); (D.N.)
| | - Alina Cristina Barb
- Department II of Microscopic Morphology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania; (F.Z.); (A.C.B.); (C.-S.D.); (D.N.)
| | - Cristina-Stefania Dumitru
- Department II of Microscopic Morphology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania; (F.Z.); (A.C.B.); (C.-S.D.); (D.N.)
| | - Talida Georgiana Cut
- Department XIII, Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania;
- Center for Ethics in Human Genetic Identifications, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Hossam Ismail
- Department of Urology, Lausitz Seeland Teaching Hospital, University of Dresden, Maria-Grollmuß-Straße, No. 10, 02977 Hoyerswerda, Germany;
| | - Dorin Novacescu
- Department II of Microscopic Morphology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania; (F.Z.); (A.C.B.); (C.-S.D.); (D.N.)
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Abstract
Minimally invasive adrenalectomy has become the gold standard for removal of benign adrenal tumors. The imaging characteristics, biochemical evaluation, and patient selection for laparoscopic transabdominal and posterior retroperitoneoscopic approaches are discussed with details of surgical technique for both procedures.
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Affiliation(s)
- Azadeh A Carr
- Section of Endocrine Surgery, Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Tracy S Wang
- Section of Endocrine Surgery, Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
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Chehade LK, Lambert V, Kollias J, Otto S. Bronchogenic cyst: the rarest adrenal incidentaloma. ANZ J Surg 2015; 88:243-245. [PMID: 26381197 DOI: 10.1111/ans.13322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Luke K Chehade
- Department of Breast, Endocrine and Surgical Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Virginia Lambert
- Department of Breast, Endocrine and Surgical Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - James Kollias
- Department of Breast, Endocrine and Surgical Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sophia Otto
- Department of Surgical Pathology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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