title: Posterior retroperitoneoscopic adrenalectomy--results of 560 procedures in 520 patients.
abstract: BACKGROUND
  The posterior retroperitoneoscopic adrenalectomy is less popular than the laparoscopic transabdominal method. Due to the direct approach to the adrenal glands, however, the posterior retroperitoneal access is easy to use and may offer advantages not available with other endoscopic procedures for adrenalectomy.
  
  
  METHODS
  Between July 1994 and March 2006, we performed 560 adrenalectomies (right side: n = 258; left side: n = 302) by the posterior retroperitoneoscopic approach in 520 patients (200 male, 320 female; age, 10 to 83 years). Of the 520 patients, 21 suffered from Cushing's disease, 499 patients had adrenal tumors (157 Conn's adenomas, 120 pheochromocytomas [13 bilateral], 110 Cushing's adenomas [6 bilateral], and 112 other tumors). Tumor size ranged from 0.5 to 10 cm (mean, 2.9 +/- 1.7 cm). The procedures were performed with the patients in the prone position usually with 3 trocars.
  
  
  RESULTS
  Mortality was zero. Conversions to open or laparoscopic lateral surgery were necessary in 9 patients (1.7%). Major complications occurred in 1.3% of patients, minor complications in 14.4%. Mean operating time was 67 +/- 40 min and declined significantly (P < .001) from the early procedures (106 +/- 46 min) to the later operations (40 +/- 15 min).
  
  
  CONCLUSIONS
  The posterior retroperitoneoscopic adrenalectomy is a safe and fast procedure. In experienced hands, this method represents the ideal approach in adrenal surgery.
authors.affiliation: Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Akademisches Lehrkrankenhaus der Universität Essen, Germany. mkwalz@kliniken-essen-mitte.de
authors.forename: Martin K
authors.initials: MK
authors.lastname: Walz
authors.forename: Piero F
authors.initials: PF
authors.lastname: Alesina
authors.forename: Frank A
authors.initials: FA
authors.lastname: Wenger
authors.forename: Anastasios
authors.initials: A
authors.lastname: Deligiannis
authors.forename: Eduard
authors.initials: E
authors.lastname: Szuczik
authors.forename: Stephan
authors.initials: S
authors.lastname: Petersenn
authors.forename: Andreas
authors.initials: A
authors.lastname: Ommer
authors.forename: Harald
authors.initials: H
authors.lastname: Groeben
authors.forename: Klaus
authors.initials: K
authors.lastname: Peitgen
authors.forename: Onno E
authors.initials: OE
authors.lastname: Janssen
authors.forename: Thomas
authors.initials: T
authors.lastname: Philipp
authors.forename: Hartmut P H
authors.initials: HP
authors.lastname: Neumann
authors.forename: Kurt W
authors.initials: KW
authors.lastname: Schmid
authors.forename: Klaus
authors.initials: K
authors.lastname: Mann
mesh_terms: D000293:Adolescent; D000311:Adrenal Glands / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D016896:Treatment Outcome