Scribd Logo
Upload

Welcome to Scribd!

  • Posterior Retroperitoneoscopic Adrenalectomy

    Uploaded by

    Shrey
    26 views14 pages
    Posterior retroperitoneoscopic adrenalectomy is a minimally invasive technique for removing adrenal glands. It has several advantages over traditional open or laparoscopic approaches, including no need for visceral mobilization or changing position for bilateral surgeries. While initially there were concerns about hemodynamic changes and technical challenges, studies have shown the learning curve is short for experienced endoscopic surgeons following proper steps. Outcomes including operating time, tumor size treated, and use in obese patients continue to improve, making it a superior option to traditional approaches for adrenalectomy.

    Original Description:

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    Posterior retroperitoneoscopic adrenalectomy is a minimally invasive technique for removing adrenal glands. It has several advantages over traditional open or laparoscopic approaches, including no need for visceral mobilization or changing position for bilateral surgeries. While initially there were concerns about hemodynamic changes and technical challenges, studies have shown the learning curve is short for experienced endoscopic surgeons following proper steps. Outcomes including operating time, tumor size treated, and use in obese patients continue to improve, making it a superior option to traditional approaches for adrenalectomy.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pptx, pdf, or txt
    26 views14 pages

    Posterior Retroperitoneoscopic Adrenalectomy

    Uploaded by

    Shrey
    Posterior retroperitoneoscopic adrenalectomy is a minimally invasive technique for removing adrenal glands. It has several advantages over traditional open or laparoscopic approaches, including no need for visceral mobilization or changing position for bilateral surgeries. While initially there were concerns about hemodynamic changes and technical challenges, studies have shown the learning curve is short for experienced endoscopic surgeons following proper steps. Outcomes including operating time, tumor size treated, and use in obese patients continue to improve, making it a superior option to traditional approaches for adrenalectomy.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pptx, pdf, or txt
    of 14

    Posterior Retroperitoneoscopic

    Adrenalectomy
    The technique
    • Bartel, 1969
    – “Retroperitoneoscopy: an endoscopic method for
    inspection & bioptic examination of
    retroperitoneal space”

    • Gaur- Balloon technique


    • Mercan, Mandrassi

    • Martin K Walz- 1995


    • MIS for pheochromocytoma- initial
    reservations
    – Adverse hemodynamics
    • Pneumoperitoneum
    • Gland manipulation

    – Technical challenges
    • Large sizes
    • Vascularity
    Advantages

    • No visceral mobilization

    • Not affected by prior surgery

    • No intraperitoneal insufflation

    • No change of position for bilateral surgery


    The learning curve

    • Cognitive reorientation of anatomy


    – Perhaps the only change required

    • Same skills

    • A learning curve not protracted


    • Barczynski et al
    • PRA method can be applied with maximum
    safety.

    • The learning phase of PRA is short


    – well-trained endoscopic surgeon
    – strictly follow the operative steps.

    • The supervision and assistance in very few


    initial surgeries
    Time taken for stabilization

    Barczynski 110 min (20) 75 min(+20) 60 min

    Lin (2015) 140 min (40) 110 min (+30) 70-80 min

    Cabalag (2014) 120 min (10) 90 min(+5) 60 min (30)

    Kiriakopoulos 140 min (10) 100 min (+10) 60 min


    (2014)

    Uitert (2017) 100 min (20) 83 min (+20) 65 min (50)


    Operating time
    LA RPA

    Paxton (46), 2011 144.8 +/- 42.4 99.9 +/- 23.0

    Lee (52), 2012 108.3 +/- 34.5 87.2 +/- 27.6

    Constantinides (71), 131.69 +/- 46.55 86.29 +/- 49.52


    2013

    Chai (48), 2014 92.2 +/- 27 78.1 +/- 18.9

    Kiriakopoulos, 2014 127 +/- 23.7 81.68 +/- 16.93

    Uitert (102), 2017 90 +/- 39 57 +/- 26


    Tumor size
    • Feasible for larger tumors also!

    • 110 out of 1400, more than 5 cm

    Wang B et al. Anatomic Retroperitoneoscopic Adrenalectomy for Selected Adrenal Tumors >5 cm: Our Technique and Experience
    Obesity
    • Pavel Zonča, 2014
    • 137 patients with 41 obese
    Obesity- Cushing’s syndrome
    • Raffaeli et al (2013)
    Other advantages
    • Single incision apparatus
    – SARA

    • Pediatric patients

    • Economical!
    – Same equipment
    – Lesser hospital stay
    – Lesser need for medications/ transfusion
    Conclusions

    • Not only alternative, probably superior too!

    • Learning curve- not long as perceived before

    • Beneficial to both patient and surgeon

    You might also like