Posterior Retroperitoneal Laparoscopic Adrenalectomy: An Anatomical Essay and Surgical Update.

Simple Summary: This paper explores a modern surgical technique called posterior retroperitoneal laparoscopic adrenalectomy (PRLA), which is used to remove the adrenal glands. Unlike traditional open surgery, PRLA uses small incisions in the patient's back, allowing surgeons to access the adrenal glands directly without disturbing other organs in the abdomen. Here, we explain the complex anatomy involved, describe how surgeons perform this procedure step by step, and discuss its benefits and challenges. PRLA can lead to less pain after surgery, shorter hospital stays, and quicker recovery for patients. However, it requires surgeons to have a deep understanding of the body's structure from a different angle than they are used to. This technique is becoming increasingly popular, but it is not suitable for every patient. Our goal is to help surgeons better understand PRLA, potentially improving outcomes for patients who need adrenal gland surgery. Posterior retroperitoneal laparoscopic adrenalectomy (PRLA) has emerged as a revolutionary, minimally invasive technique for adrenal gland surgery, offering significant advantages over traditional open approaches. This narrative review aims to provide a comprehensive update on PRLA, focusing on its anatomical foundations, surgical technique, and clinical implications. We conducted an extensive review of the current literature and surgical practices to elucidate the key aspects of PRLA. The procedure leverages a unique "backdoor" approach, accessing the adrenal glands through the retroperitoneum, which necessitates a thorough understanding of the posterior abdominal wall and retroperitoneal anatomy. Proper patient selection, meticulous surgical planning, and adherence to key technical principles are paramount for successful outcomes. In this paper, the surgical technique is described step by step, emphasizing critical aspects such as patient positioning, trocar placement, and adrenal dissection. PRLA demonstrates reduced postoperative pain, shorter hospital stays, and faster recovery times compared to open surgery, while maintaining comparable oncological outcomes for appropriately selected cases. However, the technique presents unique challenges, including a confined working space and the need for surgeons to adapt to a posterior anatomical perspective. We conclude that PRLA, in the right clinical setting, offers a safe and effective alternative to traditional adrenalectomy approaches. Future research should focus on expanding indications and refining techniques to further improve patient outcomes. [ABSTRACT FROM AUTHOR]