[The risks of retroperitoneoscopic adrenalectomy].

Area of Science:

• Urology
• Minimally Invasive Surgery
• Surgical Complications

Background:

• Minimally invasive adrenalectomy, particularly the retroperitoneoscopic dorsal approach, is the standard for suprarenal gland surgery.
• This case report focuses on potential complications of retroperitoneoscopic adrenalectomy, specifically intraoperative inferior vena cava (IVC) injury.

Observation:

• A 47-year-old male with Conn's syndrome underwent retroperitoneoscopic adrenalectomy for a right-sided adrenal adenoma.
• During the procedure, an injury to the inferior vena cava occurred but was managed intraoperatively.
• The retroperitoneal pressure tamponaded the bleeding, allowing for repair with a continuous stitch without conversion to open surgery.

Findings:

• Retroperitoneoscopic adrenalectomy can lead to severe complications like IVC injury.
• Successful repair of IVC injury is achievable using the retroperitoneoscopic technique.
• Elevated retroperitoneal pressure (20 mm Hg) poses a risk of air embolism with an open IVC lumen.

Implications:

• This case demonstrates the feasibility of managing intraoperative IVC injury during retroperitoneoscopic adrenalectomy.
• Surgeons should be prepared for and skilled in managing such vascular complications within a minimally invasive setting.
• While retroperitoneoscopy is a gold standard, awareness and management of potential severe complications are crucial.