Laparoscopic Adrenalectomy: Retroperitoneal Approach

Posterior retroperitoneoscopic adrenalectomy has emerged as an alternative operative approach for the laparoscopic removal of non-malignant tumors of the adrenal gland. Retroperitoneoscopic adrenalectomy offers advantages to transperitoneal adrenalectomy and may be the ideal approach in patients with anticipated extensive adhesions from prior abdominal surgery in the same quadrant or in patients requiring bilateral adrenalectomy as this approach avoids patient repositioning. The retroperitoneoscopic approach has been shown to be associated with operative times, complications, and mortality that are equivalent to adrenalectomy via the transperitoneal approach. Partial or cortical-sparing procedures have also been performed with favorable results. In this chapter, we describe the background, rationale, indications and contraindications, preoperative preparation, and operative technique.