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Right Posterior Retroperitoneoscopic Adrenalectomy (PRA)
Tags: General Surgery
Table of Contents
1. Introduction
- Patient positioning
- Identification of external landmarks
- Marking
2. Surgical Approach for right PRA
- Perform transverse incision just inferior to tip of the 12th rib
- Sharp entry into the retroperitoneum
- Use finger to manually and bluntly create a small open retroperitoneal space
- Placement of 5 mm medial and lateral ports under manual guidance
- Place 10 mm balloon port and insufflate the retroperitoneum
- LigaSure to open the retroperitoneal space
- Identify the paraspinal muscles and the superior pole of the kidney
- Mobilize the adrenal gland inferiorly and retract the kidney downward
- Identify the IVF and mobilize the adrenal gland off the surface, medially and laterally
- Identify the adrenal vein; clip and divide
- Divide the superior attachments suspending the adrenal gland
- Place the gland in an Endocatch device and remove it from the retroperitoneum
- Inspect for hemostasis
3. Closure
- Close the fascia in the 10 mm port site
- Close the skin