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Posterior Retroperitoneoscopic Adrenalectomy

Prone retroperitoneal endoscopic adrenal resection avoiding peritoneal cavity entry.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Posterior Retroperitoneoscopic Adrenalectomy?

Posterior retroperitoneoscopic adrenalectomy (PRA, Walz technique) is a minimally invasive endoscopic approach performed with the patient prone-jackknifed; the retroperitoneum is accessed directly through three 5-12 mm trocars below the 12th rib.

It is suitable for benign adrenal lesions <6-7 cm including aldosteronoma (Conn's adenoma), pheochromocytoma, cortisol-secreting adenoma (Cushing) and hereditary syndromes (MEN2, VHL); avoids peritoneal cavity adhesions and is particularly advantageous for bilateral adrenalectomy.

Compared with the lateral transabdominal laparoscopic approach, PRA offers shorter operative time (especially in bilateral cases), reduced blood loss, less postoperative pain, faster oral intake and earlier hospital discharge.

Symptoms

Resistant hypertension and hypokalaemia (Conn)
Episodic hypertension, palpitations, sweating (pheo)
Cushingoid features and central obesity
Adrenal incidentaloma >4 cm
Bilateral adrenal hyperplasia (MEN2)
Functional adrenal mass on hormonal workup
Failed medical therapy of adrenal hyperfunction

Risk Factors

Functional adrenal adenoma (Conn, Cushing)
Pheochromocytoma <6 cm
Multiple endocrine neoplasia type 2 (MEN2)
Von Hippel-Lindau disease
Bilateral adrenal disease
Previous abdominal surgery (peritoneal adhesions)
Adrenal incidentaloma with growth or hormonal activity

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Resistant hypertension with low potassium
  • Cushingoid features and weight gain
  • Episodic hypertension and palpitations
  • Adrenal mass on imaging needing surgical evaluation

Treatment Methods

01
Hormonal workup (aldosterone-renin, plasma metanephrines, cortisol)
02
Cross-sectional imaging (CT/MRI adrenal protocol)
03
Alpha-blockade for pheochromocytoma preparation
04
Prone-jackknife position with 3 trocars below 12th rib
05
Endoscopic adrenal dissection and ligation of adrenal vein
06
Specimen extraction in retrieval bag
07
Postoperative monitoring of haemodynamics and steroid replacement

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Genel Cerrahi Department

Let us help you

You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.