V11-10: Robot assisted partial adrenalectomy for functioning adrenal masses
We present two cases of robotic partial adrenalectomy performed in a 54yr-old female with a 3 cm left adrenal mass and increased levels of urinary metanephrines and in a 40 yr-old female with a 2 cm left adrenal mass and increased levels of serum aldosterone, respectively.
In the first case, with the patient in a flank position, a four trocar access was performed; Gerota' s fascia was incised at the level of the upper pole and the adrenal gland identified; the medial aspect of the gland was bluntly dissected and some minor vessels feeding the mass were selectively clip legated and divided; the mass was progressively mobilised starting from the medial aspect and an enucleation was performed in order to maximize the adrenal parenchyma spared; the specimen was macroscopically inspected to ensure the absence of any margin violation and it was placed into an endobag for extraction. The second case shows the same surgical access. Enucleation was performed as previously described, and a sliding clip suture was performed to approximate the margins of the adrenal gland; pathological evaluation showed the presence of an intact 1,5 mm capsule all around the adenoma, with a small rim of adrenal cortex parenchyma.
Intraoperative blood loss was negligible, postoperative course was uneventful in both cases and patients were discharged on second postoperative day._x000D_ Both patients bacame normotensive immediately after surgery. _x000D_ Both the patients were referred to endocrinological consultation after discharge. Aldosterone and potassium levels for the first patient, as well as urinary metanephrines for the second patient were in the normal range._x000D_
Robotic partial adrenalectomy is a safe, feasible and minimally technique; robotic platform facilitates either tumor enucleation or parenchymal suture. An increasing adoption of adrenal sparing surgery is likely to be anticipated.