V4-12: Robot-Assisted Retroperitoneoscopic Adrenalectomy for Pheochromocytoma

Video

Introductions and Objectives
Although robot-assisted laparoscopic transperitoneal adrenalectomy was first described in 2001, the robotic retroperitoneoscopic method has only recently been described. Robotic retroperitoneoscopic adrenalectomy may be performed via a prone posterior or lateral approach. A retroperiteonoscopic approach provides direct access to the adrenal gland and associated vasculature without the need for mobilization of the colon, liver, or spleen. It may also be favorable for patients with extensive prior abdominal surgery.

Methods
We apply a lateral retroperitoneoscopic technique for robotic adrenalectomy, using a four-arm port configuration. The patient is placed in full lateral flank position. Herein, we demonstrate the technique for removal of a 6.5 cm right adrenal pheochromocytoma. We report perioperative outcomes with this approach.

Results
We performed robotic retroperitoneoscopic adrenalectomy in 3 patients. All were right-sided tumors. Indications included pheochromocytoma, aldosteroma, and adrenal adenoma. The mean age, BMI, and tumor size were 55.3 years, 23.7 kg/m2 and 4.6cm (range, 1.8-6.5) respectively. In our initial experience, mean operative time was 133.3 minutes (range, 109-191) with median estimated blood loss of 53cc (range, 10-125). There were no intraoperative complications. In contrast to the posterior technique, the lateral approach yields a larger working space and affords the ability to add an assistant port as well as an additional robotic arm.

Conclusions
We demonstrate our technique for robotic retroperitoneoscopic adrenalectomy using the lateral approach. This approach can be safely performed for large adrenal masses, including pheochromocytoma, and may be advantageous in patients with a hostile abdomen.

Funding: none