Bilateral Posterior Retroperitoneoscopic Adrenalectomy with Cortical Sparing on Right Side

1. Introduction

1. Patient positioning
2. Identification of external landmarks
3. Marking

2. Surgical approach for right PRA

1. Perform transverse incision just inferior to tip of the 12th rib
2. Sharp entry into the retroperitoneum
3. Use finger to manually bluntly create a small open retroperitoneal space
4. Placement of 5-mm medial and lateral ports under manual guidance
5. Place 10-mm balloon port and insufflate the retroperitoneum
6. LigaSure to open the retroperitoneal space
7. Identify the paraspinal muscles and the superior pole of the kidney
8. Mobilize the adrenal gland inferiorly and retract the kidney downward
9. Identify the IVF and mobilize the adrenal gland off the surface, medially and laterally
10. Identify the adrenal vein, preserve if possible, otherwise clip and divide
11. Divide the normal adrenal parenchyma from the culprit tumor
12. Divide the superior attachments suspending the adrenal gland
13. Place the gland in an Endocatch device and remove it from the retroperitoneum
14. Inspect for hemostasis

3. Closure

1. Close the fascia in the 10-mm port site
2. Close the skin