Adrenal and renal surgery by the laparoscopic and/or retroperitoneoscopic approach

Since its introduction 6 years ago, almost all abdominal procedures have been attempted laparoscopically. Despite their retroperitoneal location, kidneys and adrenals have also been reached by the blitz of endoscopic surgery since 1992. We present here the techniques, indications, advantages or disadvantages of the videoscopic approach-either laparoscopic or retroperitoneoscopic- of those solid retroperitoneal organs. Preliminary results of the international literature are presented, while objectively comparing currently available data about the efficacy and cost of endoscopic versus open procedure. Despite the time-consuming nature and high operative cost of the endoscopic approach, decreased convalescence and better patient comfort are evident. Furthermore videoendoscopic adrenal surgery performed, even sporadically, by surgeons experienced in laparoscopic surgery is as safe as the open approach, provided that those surgeons are also familiar with the rules and potential drawbacks of adrenal surgery for endocrine disorders.