[Posterior Retroperitoneoscopic adrenalectomy in the prone position. Initial experience.]

OBJECTIVE: Transperitoneal laparoscopic adrenalectomy (TLA) is considered the treatment of choice for small and benign adrenal tumors. In the recent years, posterior retroperitoneoscopic adrenalectomy (PRA) has gained popularity due to its advantages over TLA, presenting a shorter surgical time and a faster recovery without increasing complications. Conversely, a greater learning curve is considered because the use of a different and unusual surgical field.

MATERIAL AND METHODS: Our objective is to describe the PRA technique to ass our initial experience evaluating its feasibility, safety and effectiveness in a prospective series of patients. A total of 11 (9 left and 2 right) PRA performed between March 2017 and February 2020 were analyzed.

RESULTS: Median age was 55 (36-65) years with a median BMI of 25.69 (20.8-34.5) Kg/m2. 54.55% had ASA≥3. 63.37% of adrenal tumors were hormonally functional. The tumor mean size was 4 cm (0.6-8) and cortical adenoma was the predominant pathological anatomy (72.72%). No pheochromocytoma was operated. Median operative time was 87 minutes (35-125) with an intraoperative bleeding of 50 (0-300) mL. No patient presented intraoperative complications or reconversion. Median length of stay was 1 (1-6) days. Only one patient presented postoperative complications.

CONCLUSION: The PRA is feasible, reproducible and safe, even during the initial learning curve, presenting a clear early recovery with a shorter surgical time.