Category: Laparoscopic/ Robotic: Adrenal

Introduction & Objective :

Since its introduction, robotic surgery has gained popularity in many urological surgeries, adrenalectomy being no exception. First robot assisted radical adrenalectomy on da Vinci system was performed in 2001. From this experience, robotic adrenalectomy emerged as an extremely promising procedure, capable of overcoming the technical shortcomings of laparoscopy. Robotic approach also has the upper hand in certain challenging situations such as large adrenal masses, obese patients and masses adherent to surrounding structures.

We hereby report a case of a robotic adrenalectomy, done for a large, grossly adherent adrenal mass in a patient with central obesity and a BMI of 32 kg/m².

Methods :

A 66-year-old gentleman presented with an incidentally detected mass lesion in the left suprarenal region. On evaluation, he was diagnosed to have a heterogeneously enhancing large left adrenal mass lesion of size 9x8 cm with central necrosis, abutting all adjacent structures. The metabolic evaluation was normal. The patient underwent robot-assisted adrenalectomy with da Vinci Xi system. Intraoperatively there was a large left adrenal mass with dense adhesions to the tail of the pancreas, descending colon and upper pole of left kidney.

Results :

Total console time was 100 minutes. The procedure could be completed safely without the need for open conversion. Estimated blood loss was 200 ml. Patient had an uneventful recovery and was discharged on postoperative day 2. Pathology demonstrated cavernous hemangioma with no evidence of malignancy. On 5 months follow up, the patient is doing well.

Conclusions :

Robot-assisted laparoscopic adrenalectomy is technically safe and feasible. Although challenging, even large masses with gross adhesions can be safely tackled with this approach due to distinct advantages in terms of visualisation and dexterity, and also by limiting the intraoperative complications.

Presenting Author(s)

• SP

  Saurabh Patil

  – Fellow, Robotic Uro-oncology, Max Institute of Cancer care, New Delhi, India, Bhoiwada, Mumbai, Maharashtra, India

Author(s)

• AT

  Ashwin Tamhankar

  – Fellow, Robotic Uro-oncology, Max Institute of Cancer care, New Delhi, India, Mumbai, Maharashtra, India
• SO

  Surya Ojha

  – Supervisor, Robotic Surgery program, Max Institute of Healthcare, New Delhi, India, New Delhi, Delhi, India
• PA

  Puneet Ahluwalia

  – Consultant, Uro-oncology And Robotic Surgery, Max Institute of Cancer care, New Delhi, India, Gurgaon, Delhi, Delhi, India
• GG

  Gagan Gautam

  – Head, Urologic oncology And Robotic Surgery, Max Institute of Cancer care, New Delhi, India, Gurgaon, Delhi, Delhi, India