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Operative Technique |

Robotic Posterior Retroperitoneal Adrenalectomy:  Operative Technique

Eren Berber, MD; Jamie Mitchell, MD; Mira Milas, MD; Allan Siperstein, MD
Arch Surg. 2010;145(8):781-784. doi:10.1001/archsurg.2010.148.
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Published online

Objective  To describe a robotic technique for posterior retroperitoneal (PR) adrenalectomy.

Design  Prospective study.

Setting  Academic hospital.

Patients  Twenty-three patients had robotic adrenalectomy within a year. Of these, 8 cases were done using a PR approach.

Main Outcome Measures  Feasibility of the robotic approach, patient and tumor characteristics, operative time, and complications.

Results  There were 5 women and 3 men (mean age, 52 years). There were no conversions to laparoscopic or open surgery. Pathology included benign adrenocortical adenoma in 3 patients, aldosteronoma in 2, and pheochromocytoma, subclinical Cushing syndrome, and lymphangioma in 1 patient each. The right and left sides were each involved in 4 patients. The mean (SD) tumor size was 2.9 (1.7) cm. The procedures were done using 3 trocars and 5-mm robotic instruments. The mean (SD) operative time was 214.8 (40.8) minutes; docking time, 21.7 (16.6) minutes; and console time, 97.1 (24.2) minutes. Estimated blood loss was 24 (35) mL. All patients were discharged to home in 24 hours. There were no complications. Subjectively, the dissection was felt to be easier with the robotic technique compared with the laparoscopic approach owing to the improved dexterity of the instruments.

Conclusions  To our knowledge, this is the first article describing robotic PR adrenalectomy, and we have demonstrated the technique to be feasible and safe. Owing to the limitations of a conventional laparoscopic PR approach, we believe that use of the robot is a refinement of the technique.

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Figures

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Figure 1.

With percutaneous ultrasound, the 12th rib, kidney, and adrenal gland have been marked on the skin in this patient with a left-sided pheochromocytoma. Topographic anatomy of these structures guides subsequent trocar placement.

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Figure 2.

The placement of ports. It is important to insert the working ports as far away as possible from the camera port. The camera port is a long, 12-mm trocar, and the working ports are 5-mm robotic trocars.

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Figure 3.

Intraoperative photograph shows the robotic system after docking for dissection of the adrenal gland. A down-viewing 30° scope is used with a grasping instrument from the lateral and Harmonic scalpel from the medial port.

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Figure 4.

Intraoperative photos show robotic dissection of the adrenal gland. Owing to the angulation of the grasping instrument, there is no collision with the Harmonic scalpel. Furthermore, the range of motion is much better compared with rigid laparoscopic instruments, making dissection easier.

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Figure 5.

Line graph shows the time spent docking the robot and on the robotic console for dissection of the adrenal gland.

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