Feciche Bogdan Ovidiu, Barbos Vlad, Big Alexandru, Porav-Hodade Daniel, Cumpanas Alin Adrian, Latcu Silviu Constantin, Zara Flavia, Barb Alina Cristina, Dumitru Cristina-Stefania, Cut Talida Georgiana, Ismail Hossam, Novacescu Dorin
Department of Surgical Disciplines, Discipline of Urology, Faculty of Medicine and Pharmacy, University of Oradea, University Street, No. 1, 410087 Oradea, Romania.
Department of Urology, Emergency County Hospital Oradea, Gheorghe Doja Street, No. 65, 410169 Oradea, Romania.
Cancers (Basel). 2024 Nov 15;16(22):3841. doi: 10.3390/cancers16223841.
Posterior retroperitoneal laparoscopic adrenalectomy (PRLA) has emerged as a revolutionary, minimally invasive technique for adrenal gland surgery, offering significant advantages over traditional open approaches. This narrative review aims to provide a comprehensive update on PRLA, focusing on its anatomical foundations, surgical technique, and clinical implications. We conducted an extensive review of the current literature and surgical practices to elucidate the key aspects of PRLA. The procedure leverages a unique "backdoor" approach, accessing the adrenal glands through the retroperitoneum, which necessitates a thorough understanding of the posterior abdominal wall and retroperitoneal anatomy. Proper patient selection, meticulous surgical planning, and adherence to key technical principles are paramount for successful outcomes. In this paper, the surgical technique is described step by step, emphasizing critical aspects such as patient positioning, trocar placement, and adrenal dissection. PRLA demonstrates reduced postoperative pain, shorter hospital stays, and faster recovery times compared to open surgery, while maintaining comparable oncological outcomes for appropriately selected cases. However, the technique presents unique challenges, including a confined working space and the need for surgeons to adapt to a posterior anatomical perspective. We conclude that PRLA, in the right clinical setting, offers a safe and effective alternative to traditional adrenalectomy approaches. Future research should focus on expanding indications and refining techniques to further improve patient outcomes.
后腹腔镜肾上腺切除术（PRLA）已成为肾上腺手术的一项革命性微创技术，与传统开放手术相比具有显著优势。本叙述性综述旨在全面更新PRLA，重点关注其解剖学基础、手术技术及临床意义。我们对当前文献和手术实践进行了广泛回顾，以阐明PRLA的关键方面。该手术采用独特的“后门”入路，通过腹膜后间隙进入肾上腺，这需要对后腹壁和腹膜后解剖结构有透彻的了解。正确的患者选择、细致的手术规划以及遵循关键技术原则对于取得成功的手术效果至关重要。本文将逐步描述手术技术，重点强调患者体位、套管针置入和肾上腺分离等关键环节。与开放手术相比，PRLA术后疼痛减轻、住院时间缩短、恢复更快，同时对于适当选择的病例，其肿瘤学疗效相当。然而，该技术也带来了独特的挑战，包括操作空间有限以及外科医生需要适应后位解剖视角。我们得出结论，在合适的临床环境中，PRLA为传统肾上腺切除术提供了一种安全有效的替代方法。未来的研究应聚焦于扩大适应证范围和完善技术，以进一步改善患者预后。
