Retroperitoneoscopic Left Adrenalectomy in a 2-Year-Old

Introduction: The traditional approach for adrenalectomy in children has been the transperitoneal technique. In adults, the posterior retroperitoneoscopic (PR) approach has been promoted. 1–4 This method, however, has not been widely adopted in the pediatric population. 5 Our video demonstrates a PR approach to the left adrenalectomy in a 2-year-old female with hemihypertrophy and thelarche. She was found to have an adrenal adenoma. Run time for the video is 211 seconds. Materials and Methods: Our patient was placed in a prone position, supported by one gel roll at the level of the chest and one at the pelvis. The sacrospinalis muscle, 12th rib, and iliac crest were identified. An 8-mm incision was made over the lumbar triangle, below the 12th rib, and at the lateral border of the paraspinal muscle. A 5-mm trocar was introduced through this incision, and entry to the retroperitoneum was gained by piercing the thoracolumbar fascia. A retroperitoneal cavity was then developed by insufflating the space to a pressure of 20 mm Hg. In conjunction, blunt dissection using the endoscope and a laparoscopic kittner was utilized. Two additional 5-mm trocars were inserted once an adequate working space had been created. Gerota's fascia was incised and perinephric fat was dissected away from structures of interest. The adrenal vein was then identified and ligated, as were smaller feeding vessels. Clips were used for larger vessels and a harmonic scalpel for smaller ones. The adrenal gland was freed of its attachments and was delivered using an augmented 5-mm endocatch bag. Results and Conclusions: PR left adrenalectomy was tolerated well in this 2-year-old, supporting the approach for safe excision of pediatric adrenal tumors. Our patient was discharged home on the second postoperative day. No competing financial interests exist. This is an IRB approved project that has never been previously presented. Runtime of video: 3 mins 51 secs