V4-11: Robot-assisted radical adrenalectomy with excision of adrenal vein thrombus.

Video

Introductions and Objectives
The presence of neoplastic thrombus in the renal or adrenal vein is often considered a contra-indication to perform minimal invasive surgery for either kidney or adrenal tumors. We present the feasibility of Robot-assisted radical adrenalectomy (RARA) with excision of an adrenal vein thrombus

Methods
A 54-year-old male was referred to our department with a right adrenal tumor with an adrenal vein thrombus. After informing the patient, a RARA was scheduled. The patient was placed in a flank position with the table slightly flexed. A transperitoneal approach was decided using the standard partial nephrectomy port setting. After mobilizing the right colonic flexure and the duodenum, the right adrenal vein was identified. The Adrenal was dissected free from all its attachments leaving its vein intact. Two robotic bulldogs were used to clamp the vena cava in a wedge configuration below the adrenal vain. A robotically manipulated ultrasound probe confirmed the extent of the thrombus in order to achieve complete resection. After resecting the adrenal with its vein and thrombus en-block, the vena cava was sutured continuously. The specimen was placed in an endoscopic bag and was retrieved

Results
Console time was 94 min and the blood loss was minimal (40cc). Convalescence was uneventful. The drain was removed at the first postoperative day, and patient was discharged at the third postoperative day. The Pathology report confirmed negative surgical margins

Conclusions
Robot-Assisted Radical Adrenalectomy (RARA) with thrombectomy and vascular reconstruction of the vena cava can be safe, feasible and effective in experienced hands. The use of the robotic bulldogs are essential for the precise clamping and suturing of the vena cava giving the control to the console surgeon.

Funding: None