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A Journal on Surgery

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Minerva Chirurgica 2018 February;73(1):93-9

DOI: 10.23736/S0026-4733.17.07465-X


language: English

Considerations in minimally invasive adrenal surgery: the frontdoor or the backdoor?

Otis M. VRIELINK, Patrick H. HEMMER, Schelto KRUIJFF

Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands


Over the last few decades, in the field of minimally invasive adrenal surgery, retroperitoneoscopic adrenalectomy (PRA) has shown favorable results when compared to laparoscopic transperitoneal adrenalectomy (LTA). However, for many endocrine surgeons it is unclear if, when, and how to transition from LTA to PRA. Although the length of the learning curve for both approaches is comparable, the LTA is a technically more challenging procedure whilst PRA demands an orientation in a new environment in a patient that is positioned upside down. Visiting a proctor is crucial for successfully adopting the PRA procedure, and continued mentorship in a surgeon’s own hospital during the first procedures is preferable. There are several other aspects related to the decision to transition to PRA; the caseload of adrenal patients, learning aspects of other members of the team, technical considerations, case selection, and a well-developed emergency plan in case of complications during surgery. In a dedicated endocrine center with a considerable annual case load of approximately 30 procedures, we recommend to transition to PRA in order to provide the highest quality of care to adrenal patients.

KEY WORDS: Adrenalectomy - Laparoscopy - Minimally invasive surgical procedures

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Publication History

Issue published online: January 30, 2018
Article first published online: July 28, 2017
Manuscript accepted: July 28, 2017
Manuscript received: July 19, 2017

Cite this article as

Vrielink OM, Hemmer PH, Kruijff S. Considerations in minimally invasive adrenal surgery: the frontdoor or the backdoor? Minerva Chir 2018;73:93-9. DOI: 10.23736/S0026-4733.17.07465-X

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