Posterior Retroperitoneoscopic adrenalectomy in the prone position. Initial experience.

OBJECTIVE: Transperitoneal laparoscop- ic adrenalectomy (TLA) is considered the treatment of choice for small and benign adrenal tumors. In the re- cent years, posterior retroperitoneoscopic adrenalecto- my (PRA) has gained popularity due to its advantages over TLA, presenting a shorter surgical time and a faster recovery without increasing complications. Conversely, a greater learning curve is considered because the use of a different and unusual surgical field. MATERIAL AND METHODS: Our objective is to de- scribe the PRA technique to ass our initial experience evaluating its feasibility, safety and effectiveness in a prospective series of patients. A total of 11 (9 left and 2 right) PRA performed between March 2017 and Febru- ary 2020 were analyzed. RESULTS: Median age was 55 (36-65) years with a median BMI of 25.69 (20.8-34.5) Kg/m2. 54.55% had ASA≥3. 63.37% of adrenal tumors were hormonal- ly functional. The tumor mean size was 4 cm (0.6-8) and cortical adenoma was the predominant pathological anatomy (72.72%). No pheochromocytoma was oper- ated. Median operative time was 87 minutes (35-125) with an intraoperative bleeding of 50 (0-300) mL. No patient presented intraoperative complications or recon- version. Median length of stay was 1 (1-6) days. Only one patient presented postoperative complications. CONCLUSION: The PRA is feasible, reproducible and safe, even during the initial learning curve, presenting a clear early recovery with a shorter surgical time