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Considerations in minimally invasive adrenal surgery; the front- or the backdoor?

Authors
  • Vrielink, Otis M1
  • Hemmer, Patrick H1
  • Kruijff, Schelto2
  • 1 Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. , (Netherlands)
  • 2 Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands - [email protected] , (Netherlands)
Type
Published Article
Journal
Minerva chirurgica
Publication Date
Jul 28, 2017
Identifiers
DOI: 10.23736/S0026-4733.17.07465-X
PMID: 28752985
Source
Medline
License
Unknown

Abstract

In the last decades, in minimally invasive adrenal surgery, the retroperitoneoscopic adrenalectomy (PRA) has shown favorable results when compared to the laparoscopic transperitoneal adrenalectomy (LTA). However, for many endocrine surgeons it is unclear if, when, and how to transition from LTA to PRA. Although the length of the learning curve for both approaches is comparable, the LTA is a technically more challenging procedure whilst PRA demands an orientation in a new environment in a patient that is positioned upside down. Visiting a proctor is crucial for successfully adopting the PRA procedure, and continued mentorship in a surgeon's own hospital during the first procedures is preferable. There are several other aspects related to the decision to transition to PRA; the caseload of adrenal patients, learning aspects of other members of the team, technical considerations, case selection, and a well-developed emergency plan in case of complications during surgery. In a dedicated endocrine center with a considerable annual case load of approximately 30 procedures, we recommend to transition to PRA in order to provide the highest quality of care to adrenal patients.

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