The conference is a leading scientific event where new techniques and technologies related to minimally invasive surgery are presented, i.e. surgery performed entirely with small holes avoiding a large open incision.

Participating in his conference was of particular interest Mr. Aristoteli Kehagia General Surgeon, Endocrine Surgeon, specializing in Advanced Laparoscopic Surgery, Director of Surgery Clinic of Metropolitan Generalwhere he analyzed Retroperitoneal Adrenal Surgery in two speeches.

What is the adrenal gland and in which case does it need surgery?

The adrenal glands are two endocrine glands that produce hormones such as cortisol, adrenaline, aldosterone and regulate blood pressure, metabolism and other functions. The adrenal gland must be operated on when it has an adenoma (tumor) that produces hormones e.g. to treat secondary hypertension or other conditions such as Cushing’s syndrome. Also, it must be removed if it does not produce hormones, especially when it is more than 3-4 cm or when it shows an increase in size, to prevent or treat cancer.

What is the Retroperitoneal Adrenalectomy Technique?

The adrenal glands are retroperitoneal organs, that is, they are located at the back of the abdomen, essentially in the waist area. Retroperitoneal Adrenalectomy, or PRA, is the only operation which, through three small holes in the waist area, directly reaches the retroperitoneal space, where the adrenal gland is located, which it removes easily without interfering with any other organ. For this reason the method has received the name “Retroperitoneal”. In contrast, laparoscopic techniques are transperitoneal, meaning they are performed from the front or side of the abdomen with five holes and must traverse the entire abdomen moving the viscera out of place to reach the adrenal gland.

What are the advantages of PRA over laparoscopic surgery?

PRA has minimal external and internal trauma, is safe because there is no bleeding or risk of injury to abdominal organs, post-operative pain is minimal to none, hospitalization is less than 24 hours and the return to everyday life is immediate.

What was new at the Pan-European Conference?

The beginning of Mr. Kehagia’s presentation was about the classic three-hole PRA, originating from Essen, Germany. Afterwards, he presented the modifications of this technique for cases that until recently were a contraindication for surgery, such as the removal of giant tumors and the performance of the technique in morbidly obese patients. He also presented rare tumors and the new PRA 2 small holes technique, introduced at Metropolitan General in January 2023, which is the only technique in the world to remove internal tumors with only two small holes.

Since PRA is significantly superior why is there still common laparoscopic surgery?

The presidium of the Pan-European Congress recognizing the universal superiority of PRA criticized the implementation of laparoscopic surgery, urging the respective hospitals to seek training in PRA so as to stop laparoscopic or refer cases to a PRA surgeon. It is noted that PRA is a very specialized operation that requires high training and is performed in very few centers worldwide. The PRA surgeon is understood to be able to perform the laparoscopic method, but for the benefit of the patient he does not do so, preferring the safer PRA technique.