Retroperitoneoscopic adrenalectomy by a lumbodorsal approach: clinical experience with solo surgery

Laparoscopic adrenalectomy by transperitoneal approaches necessitates the r etraction of intraperitoneal organs and, hence, the creation of extra ports for retractors and assistants. The feasibility of retro-peritoneoscopic ad renalectomy by a lumbodorsal approach was assessed in 26 patients with adre nal tumors. In six patients the procedure was carried out as solo surgery u sing the ABSOP robot camera holder, and the performance was compared with t hat reported for the most recent series of six cases operated upon with one human assistant. The procedures were successful in 25 patients. One patien t had to be converted due to tension pneumothorax caused by diaphragmatic i njury. The mean blood loss was 43.5 +/- 67.5 mi, and the procedure time ave raged 144 +/- 33 min. We required an average of only 3.1 trocars to accompl ish solo surgery in 5 of 6 patients (83%). The number of lens smearings dec reased to one-fourth of that observed by a human assistant.