V7-05: Robotic Assisted Laparoscopic Adrenalectomy In The Setting Of An Incidental Adrenal Mass
Since Rudolf Virchow first described abdominal “glioma” tumors in children, neuroblastoma has come to be recognized as the most common malignancy in infants and the most common solid malignancy in children. Resection in neuroblastomas that are classified as low risk is often curative. Traditionally the standard operative management has been open surgical resection. More recently however, a shift towards minimally invasive approaches has been described. Here we report a case of neuroblastoma managed with robotic assisted laparoscopic adrenalectomy. This is the first robotic adrenalectomy performed at our institution and, to the best of our knowledge, the first performed on a Da Vinci Xi robot.
A single case was reviewed and reported.
A 2-year-old female with a history of a febrile urinary tract infection found to have a poorly functioning left upper pole moiety with ectopic ureter initially underwent a successful robotic assisted left upper pole partial nephrectomy. On her postoperative renal ultrasound, she was found to have a new right sided adrenal mass. This was confirmed with MRI and MIBG scan. Metanephrinies, homovanillic acid, and vanillylmandelic acid levels were obtained to evaluate for pheochromocytoma and were within normal limits. Robotic assisted laparoscopic right adrenalectomy was then performed. Intraoperatively, a small iatrogenic cavotomy was made and repaired. There were no further complications and the patient tolerated the procedure well. She had an uneventful recovery and was discharged home on post-operative day two.
Robotic assisted laparoscopic adrenalectomy represents a viable option for surgical excision of adrenal tumors and can be accomplished with rapid recovery time, decreased surgical morbidity, and comparable oncologic outcomes. Injury to surrounding vessels presents a known complication to adrenalectomy. Our case demonstrates the advantage of a Da Vinci Xi surgical system for laparoscopic vascular repair and tumor excision. In our experience, while adhering to sound oncologic surgical principles, a robotic assisted laparoscopic approach can be considered as an alternative to traditional open adrenalectomy for select children with neuroblastoma.