V4-14: ROBOT-ASSISTED ADRENALECTOMY: TIPS, TRICKS AND SURGICAL TECHNIQUE

Video

Introductions and Objectives
The first transabdominal laparoscopic adrenalectomy was performed in 1992, by Gagner and colleges. Shortly thereafter, laparoscopic approach became the standard of care for treatment of adrenal neoplasms mainly due to minimal patient discomfort and better outcomes when compared to open adrenalectomy. According to the most recent metanalysis, robot-assisted adrenalectomy provides the potential advantages of a shorter hospital stay and less blood loss. Our standardized surgical technique is reproducible and provides excellent outcomes.

Methods
Between January 2009 to October 2013 we have performed 60 robot-assisted adrenalectomies using our standardized technique. We systematically reviewed our video database and highlighted surgical pearls that exemplify our standardized approach. These tips and tricks are essential for a successful robot-assisted adrenalectomy for the treatment of right and left sided disease.

Results
We mention detailed surgical tips for the overall procedure when performing left and right adrenalectomy. We provide key clinical tips regarding patient positioning, port placement and essentials during the main operative steps. We present important strategies for access to the gland, control of vein and meticulous adrenal gland mobilization and dissection. We believe that adherence to the clinical pearls can lead to improvement of overall outcomes for this procedure.

Conclusions
Using a standardized surgical technique for robot-assisted adrenalectomy, surgeons can aim to have excellent outcomes, mainly by minimizing complications, decreasing blood loss and shortening hospital stay.

Funding: none