New approach to retroperitoneal laparoscopic adrenal surgeries: A new set of anesthetic challenges

Posterior retroperitoneoscopic surgeries for adrenal lesions are steadily gaining popularity over the transperitoneal approach because it allows easier surgical access and reduces the intraoperative and postoperative morbidity. Martin Walz et al. has been a pioneer in describing the modified prone jack-knife position which provides the surgeons a distinct advantage over the conventional prone jack-knife position. The technique has shown a distinct advantage in terms of reduced blood loss, lesser postoperative pain, and shorter length of hospital stay. However, this unconventional position makes some unconventional demands from the anesthetist in terms of the resources required, potential hemodynamic instability, and difficulty in ventilation. To the best of the author's knowledge, this case series is the first attempt at describing the anesthetic challenges faced during retroperitoneal laparoscopic adrenalectomy performed in this novel position. Through these five cases, we aim to provide insight into the intricacies of anesthetic management for this surgical approach with byzantine anesthetic implications.