Robotic Assisted cortical sparing left adrenalectomy

Avishai Meyer, MD, Abhijit Shaligram, MD, Dmitry Oleynikov, MD, Pradeep Pallati, MD

University of Nebraska Medical center

Introduction: Laparoscopic adrenalectomy is the standard of care for unilateral adrenal mass with pheochromocytoma. In patients with bilateral disease or with previous adrenalectomy, increasing evidence has shown the feasibility of partial adrenalectomy, which will maintain residual adrenal function so that the patients do not require further hormone replacement therapy.

Case Report: Here, we present a case of a 21 year old patient with Von Hippel Lindau syndrome who was diagnosed with right adrenal mass 6 years ago and underwent laparoscopic right adrenalectomy at that time. Now, he presented with recurrent pheochromocytoma and the presence of a nodule on the left adrenal gland. Patient was offered robotic assisted cortical sparing left adrenalectomy.

The patient is positioned in right lateral decubitus position. Four ports are placed along the left costal margin. Initial dissection of the adrenal gland is performed laparoscopically including the clipping and division of the adrenal vein. After the gland is mobilized, intra-operative ultrasound is used to locate the tumor and later the standard three-arm da Vinci Surgical System was introduced with hook dissector on the right arm and bipolar dissector on the left arm. With increased stability and three dimensional visualization from the surgical robot, the adrenal mass was then enucleated without difficulty. The patient was discharged the next day after 23-hour observation. At two month follow-up, the patient is on half dose maintenance therapy for steroids.

Conclusion: Cortical sparing partial adrenalectomy is feasible. Robotic assistance provides enhanced three-dimensional visualization and minimal manipulation of adjacent normal adrenal tissue.

Session: Video Channel Day 1

Program Number: V039

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