Robotic Adrenalectomy of Giant Pheochromocytoma

Alexander Ramirez Valderrama, MD, Robert M Dickanson, MD, Gerald J Wang, MD. New York Hospital Queens.

INTRODUCTION The definitive treatment of pheochromocytoma is surgical resection. The viability and success of laparoscopic removal of large pheochromocytoma are questionable. We present a video of a successful laparoscopic robotic resection of a 9 cm pheochromocytoma using the da Vinci Si HD System.

OBJECTIVE Document the benefits of robotic surgery in cases of giant pheochromocytoma.

METHODS We conducted a retrospective review of a single case. Data were collected from medical records and Adobe Premiere 5.5 video editing was used.

CASE REPORT 56 year-old female with a left suprarenal mass of 9 cm. The diagnosis of pheochromocytoma was made and after optimization with alpha blocker (doxazosin) and adequate hydration, the patient was taken to the operating room. The procedure was performed successfully without complications, with some fluctuations in blood pressure during tumor manipulation. Operative time was about 4 hours and estimated blood loss was 250 CC. During the immediate postoperative period the patient had an episode of hypotension, which was corrected with fluids and phenylephrine for about 2 hours. Her hospital stay was uneventful and she was discharged home on the third postoperative day. Pathology report confirmed benign pheochromocytoma of 9.0 x 7.0 x 5.8 cm.

CONCLUSION: This case shows that the robotic approach for giant pheochromocytoma can be a safe management strategy that can offer all the advantages of minimally invasive surgery using the robotic system.

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