Category: Robotic Surgery: UpperTract - Malignant

VS17-4 - Robot-assisted left adrenalectomy with left renal vein tumor thrombectomy

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective :

In this video we highlight surgical steps of a left adrenalectomy and left renal vein tumor thrombectomy.


Methods : The preoperative CT scan highlights a 7 cm left adrenal mass with a tumor thrombus extending into the left renal vein. The left renal vein was prepared and encircled with Roummel Tourniquet distally to the adrenal vein branch. After left renal artery identification , left renal vein was furtherly prepared and a tourniquet was placed proximally to the left adrenal vein branch. Left adrenal vein was hence isolated and encircled with Roummel Tourniquet.  The left renal vein and left adrenal vein Tourniquets were cinched down and a renal vein was incised and the thrombus was exposed. The thrombus was meticulously and progressively mobilized and removed, in conjunction with the adrenal vein ostium. Left adrenal vein was stapled and the specimen was secured into an endocatch bag. The left renal vein was sutured with a 3 0 monocryl suture. Tourniquet were removed, without any blood leakage from the suture. The adrenal mass was then isolated, and progressively dissected with 10 millimeters Ligasure, and the specimen was secured in an endobag. 


Results :

Operative time was 170 minutes. Perioperative course was uneventful and patient was discharged in postoperative day 5. The pathologic report showed a primary adrenocortical carcinoma. Post operative CT scan was negative.


Conclusions : Thanks to the increasing experience with robotic surgery, robot-assisted left adrenalectomy with left renal vein tumor thrombectomy was a feasible and safe treatment option in a tertiary referral center, with favourable perioperative outcomes.

Leonardo Misuraca

Fellow
"Regina Elena" National Cancer Institute, Dept. of Urology
Rome, Lazio, Italy

Giuseppe Simone

Consultant
“Regina Elena” National Cancer Institute, Dept. of Urology
Roma, Lazio, Italy

Gabriele Tuderti

Fellow
"Regina Elena" National Cancer Institute, Dept. of Urology
Roma, Lazio, Italy

Francesco Minisola

"Regina Elena" National Cancer Institute, Dept. of Urology
Roma, Lazio, Italy

Mariaconsiglia Ferriero

MD, PhD
"Regina Elena" National Cancer Institute, Dept. of Urology
Rome, Lazio, Italy

Salvatore Guaglianone

"Regina Elena" National Cancer Institute, Dept. of Urology
Roma, Lazio, Italy

Michele Gallucci

Roma, Lazio, Italy