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.
后腹腔镜肾上腺切除术（PRLA）已成为肾上腺外科领域一项革命性的微创技术，相比传统开放手术具有显著优势。本文旨在通过叙述性综述全面更新PRLA的研究进展，重点阐述其解剖学基础、手术技术及临床意义。我们系统回顾了现有文献和手术实践，以阐明PRLA的核心要点。该术式采用独特的"后路"入路，通过腹膜后间隙到达肾上腺区域，这要求术者必须全面掌握后腹壁及腹膜后解剖结构。恰当的患者选择、精细的手术规划以及关键技术原则的遵循是手术成功的关键。本文逐步详解手术技术，重点说明患者体位、套管置入和肾上腺分离等关键环节。与开放手术相比，PRLA在术后疼痛控制、住院时间和恢复速度方面表现更优，同时在严格筛选的病例中能获得相当的肿瘤学疗效。然而该技术也存在特殊挑战，包括操作空间局限以及术者需要适应后方解剖视角。我们得出结论：在合适的临床场景中，PRLA可作为传统肾上腺切除术安全有效的替代方案。未来研究应致力于拓展手术适应症并优化技术细节，以进一步提升患者预后。
Posterior Retroperitoneal Laparoscopic Adrenalectomy: An Anatomical Essay and Surgical Update
肿瘤(癌症)患者之家