title: The anterior approach to retroperitoneoscopic adrenalectomy in children: technique.
abstract: OBJECTIVE
  Very limited literature exists on minimally invasive adrenalectomy in children. Retroperitoneoscopic adrenalectomy (RPA) has the advantage of avoiding intra-abdominal organ retraction, but concerns have been expressed regarding RPA on the right side. Herein, we describe the second reported experience with the anterior approach to RPA in children, which appears to overcome the limitations previously ascribed to right RPA.
  
  
  METHODS
  Two children, aged 8 and 14-years, presented with incidental right adrenal masses. Both patients were placed in the lateral decubitus position with lumbar hyper-extension. A 5-mm, 3-port approach was used, as demonstrated in the video.
  
  
  RESULTS
  Pathology revealed a 7-cm ganglioneuroma and a 5-cm pheochromocytoma with intact surgical margins. Operative time with these large masses and first experience with this technique was 5 h in the first case and 3.5 h in the second. No intraoperative or postoperative complications were noted, with minimal blood loss and a hospital stay of 36 h in both cases.
  
  
  CONCLUSIONS
  The anterior approach to RPA is feasible even in children with a smaller retroperitoneal space and a large adrenal mass. It provides excellent exposure of the adrenal gland and vein, even on the right side.
authors.affiliation: Division of Urology, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada.
authors.forename: Waleed
authors.initials: W
authors.lastname: Eassa
authors.forename: Mohamed
authors.initials: M
authors.lastname: El-Sherbiny
authors.forename: Roman
authors.initials: R
authors.lastname: Jednak
authors.forename: John-Paul
authors.initials: JP
authors.lastname: Capolicchio
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D002648:Child; D005500:Follow-Up Studies; D005729:Ganglioneuroma / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D010673:Pheochromocytoma / Q000175:diagnosis / Q000601:surgery; D012187:Retroperitoneal Space / Q000601:surgery*; D018570:Risk Assessment; D012494:Sampling Studies; D016896:Treatment Outcome