Posterior Retroperitoneoscopic Adrenalectomy in a Renal Agenesis Patient

Abstract

Nowadays, laparoscopic adrenalectomy has been the gold standard treatment for benign surgical adrenal disease. Traditionally, the transperitoneal approach was most widely used for laparoscopic adrenalectomy. Recently, the posterior retroperitoneoscopic adrenalectomy (PRA) was introduced and it showed several benefits over the traditional approach, such as less complications and pain, and a shorter operative time and hospitalization. The number of surgeons capable of performing PRA is steadily increasing world-wide. The initial surgical step in this procedure is the identification and exposure of the upper part of kidney, which is the only visible landmark in the fat-abundant retroperitoneal space. Therefore, PRA in a renal agenesis (RA) patient is challenging for the surgeon due to the absence of surgical landmarks. In this article, we describe our experience of performing a PRA on the RA patient. The patient was a 62-year-old female, who had hypertension for 20 years. Blood examination revealed a high renin-aldosterone ratio, and computed tomography scan and adrenal venous sampling confirmed a 2.4 cm left adrenal aldosterone-producing adenoma. PRA was safely performed using three trochars. The total operation time was 55 minutes, and there were no complications.