Right Posterior Retroperitoneoscopic Adrenalectomy (PRA)

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 12^th rib
2. Sharp entry into the retroperitoneum
3. Use finger to manually and 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; clip and divide
11. Divide the superior attachments suspending the adrenal gland
12. Place the gland in an Endocatch device and remove it from the retroperitoneum
13. Inspect for hemostasis

3. Closure

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