V1861: Robotic Partial Cystectomy of a Paraganglioma

Video

Introduction and Objectives
Extra-adrenal pheochromocytomas or paragangliomas are exceedingly rare tumors rising from neural crest tissue. Those involving the urinary tract are even more uncommon, with no consensus on which surgical technique is best in management. Herein we present a case of robotic excision of a paraganglioma involving the urinary bladder.

Methods
A 56-year-old female with no significant medical history presented to her physician with a 12 month complaint of severe hot flashes, mood swings, and heart palpitations which had worsened over the last 6 months. Endocrinologic and radiographic evaluation revealed elevated urine and serum metanephrines and a 2.8cm solid, enhancing mass lying posterior to the urinary bladder, abutting the right ureter. The patient elected to undergo robotic surgical management after appropriate alpha adrenergic blockade.

Results
Cystoscopy was performed with bilateral ureteral stenting prior to incision. Ultrasound confirmed the presence of a solid mass which had migrated anterior to the bladder. Robotic dissection confirmed the mass and was then excised. The anterior bladder wall was resected to ensure a negative margin. A robotic cystorrhaphy was completed. The patient had an uneventful intraoperative and postoperative course with discharge on POD #2.

Conclusions
Robotic transperitoneal excision is a feasible minimally invasive option in the management of paragangliomas involving the urinary bladder.

Funding: None