Background:
Surgical techniques have come a long way since the first planned adrenalectomy in 1914. After almost 80 years of open adrenal surgery, laparoscopic adrenalectomy was described in 1992, and quickly became the gold standard for removal of benign adrenal tumours.

More recently, Martin Walz from Germany developed a posterior approach to adrenal surgery (PRA). PRA offers less pain, less blood loss, and faster recovery than open or anterior laparoscopic approaches. PRA is suitable for patients with benign adrenal tumours <8cm, or for a solitary metastasis to the adrenal.

Methods:
This presentation will describe the introduction of PRA to Victoria, Australia, including measures to ensure the new procedure was introduced safely.  Indications for surgery and results of the first 40 PRA procedures are described, and compared with the previous laparoscopic adrenalectomy program.

Results:
Forty successful PRA procedures have been performed in Victoria. There have been no conversions to open procedures or deaths. PRA patients used less pain medication, and had a shorter length of stay than laparoscopic adrenalectomy patients. 40% of PRA patients required no analgesia at all. Six of the last eight PRA patients have gone home on the day of surgery.

Conclusion:
PRA is the preferred approach for minimally invasive adrenalectomy in suitable patients, offering safety, less pain, faster recovery, and less hospital bed utilization than laparoscopic adrenalectomy.

PRA will be more widely available in the near future, as more Australian surgeons are undertaking training in PRA.