V11-03: Selective ischemia in Robot-assisted Partial Adrenalectomy
Partial adrenalectomy is a valuable option to treat small adrenal tumors. Nevertheless, the procedure remains underused, probably because it is technically demanding surgery. Thus, we tried to standardize the operation, to improve safety and reproducibility of the procedure. Resection of the tumor was performed in selective ischemia to maintain optimal perfusion of healthy adrenal tissue.
We used a transperitoneal robotic-assisted laparoscopic approach. The operation was structured into clearly defined steps to establish standardization: After dissection of the renal vein, the adrenal branch of the vessel is identified and the inferior vascular pedicle exposed. Subsequently the anterior and posterior faces of the gland are released from the peri-adrenal fat. This is followed by the devascularisation of the tumor, taking particular care to maintain the perfusion of healthy adrenal tissue. Then, an US endoscopic probe is used to define the resection margins. The vascular supply to the gland is temporarily closed with drop-in bulldog clamps and Indocyanine green is injected intravenously. Sufficient devascularization of the tumor is verified, using the near infrared fluorescence system (NIRF). The operation proceeds with the tumor resection and is finished by spraying the resection zone with fibrin-based haemostatic glue.
The technically demanding surgery can be facilitated by structuring the intervention into clearly defined steps. Healthy adrenal tissue can be spared by selective tumor devascularisation. Excessive bleeding can be avoided by verifying sufficient ischemia in the resection zone, using the NIRF system.
RAPAd in selective ischemia is feasible and safe in the treatment of small adrenal tumors. Standardizing the operation improves reproducibility of the procedure.