Posterior retroperitoneoscopic adrenalectomy (PRA) is a minimally invasive technique offering direct access to the adrenal glands without transgressing the peritoneal cavity. While globally recognized for its favorable outcomes, PRA remains underutilized in the Philippines, with no previously published local data.. This study aims to present the first Philippine case series on PRA, evaluating its feasibility, safety, and perioperative outcomes in a tertiary government hospital.

We conducted a retrospective review of 18 patients who underwent PRA by a single surgeon at a tertiary government hospital between January 2022 and December 2024. Collected data included patient demographics, tumor characteristics, operative time, estimated blood loss, complications (Clavien-Dindo classification), postoperative pain scores (VAS), and length of hospital stay.

Eighteen patients (14 females, 4 males; mean age 48.5 years) underwent 19 PRA procedures, including one bilateral case. Indications were primary hyperaldosteronism (55%), non-functioning adenomas (22%), and pheochromocytomas (22%). Mean tumor size was 2.9 cm (range 1.1–6.0 cm). All procedures were completed successfully via the PRA approach, with no conversions, no intraoperative complications, and no mortalities. Mean operative time was 59.1 minutes (range 43–80), with a trend toward shorter duration in later cases, indicating an early learning curve. Estimated blood loss was low (mean 28.9 mL), and no transfusions were required. Postoperative pain was minimal, with a mean VAS score of 1.6 on day one. Mean hospital stay was 2.1 days, with 83% discharged by postoperative day 2. Only one minor complication (5.5%) was noted—transient flank hypoesthesia (Clavien-Dindo I)—which resolved with conservative management. There were no major complications, reoperations, or endocrine emergencies.

This initial local experience demonstrates that PRA can be safely and effectively implemented in a Philippine tertiary hospital. Operative time, blood loss, complication rates, and length of hospital stay were all comparable to international standards (Figure 1). These findings support the broader adoption of PRA in local surgical practice for well-selected adrenal tumors.