Editing Surgery of the Adrenals (section)

===== Retroperitoneal =====
* '''Include the flank and posterior lumbodorsal approaches'''
* '''Advantages'''
*# '''Reduced risk of visceral and bowel injuries by avoiding entry into the peritoneum'''
*# '''Less ileus and shorter hospitalization'''
*# '''Ideal for the morbidly obese patient in whom the abdominal panniculus will fall forward in a flank or prone position'''
*# '''Reduced hemodynamic and respiratory morbidity in the absence of pneumoperitoneum'''
*# '''Dense intraperitoneal adhesions arising from previous surgery or inflammation are averted by operating in the retroperitoneum'''
* '''Disadvantage'''
** '''Smaller operative field''' which makes dissection of large tumors difficult
* '''Posterior lumbodorsal approach should not be used for large tumors or adrenal cortical carcinoma'''
* '''The main advantage of the flank approach over the posterior approach is the ease of conversion into the transperitoneal approach should difficulties be encountered. In contrast, the prone posterior lumbodorsal approach allows for bilateral adrenalectomy without patient repositioning.'''