Laparoscopic adrenalectomy has become the gold standard for resecting most adrenal tumors. In the United States the majority of laparoscopic adrenalectomies are done through a transabdominal approach. The major disadvantages to this approach include: 1) necessity for mobilizing other organs such as the liver and spleen 2) potential for injury to intrabdominal structures 3) potential for creating post-operative adhesions. The laparoscopic retroperitoneal adrenalectomy eliminates many of these concerns and is a safe, effective means of resecting well-selected adrenal tumors.

The patient is placed in the prone position and three ports are placed in a line at the level of the tip of rib 12. Gerota's fascia is entered bluntly and the posterior attachments of the periadrenal fat and kidney are dissected. The kidney is then retracted inferiorly. The adrenal gland is dissected free from lateral to medial allowing for identification of the inferior vena cava and the right adrenal vein. The adrenal vein is ligated. The rest of the attachments of the adrenal gland are dissected and the specimen is removed.

Laparoscopic retroperitoneal adrenalectomy allows for safe and effective adrenalectomy.