Robotic partial adrenalectomy for symptomatic aldosterone-secreting adenomas: technique and outcomes
Partial adrenalectomy for functioning adrenal masses is significantly underused.
We describe surgical technique and present perioperative and functional outcomes of a two center series including nine symptomatic aldosterone-secreting adenomas treated with robotic partial adrenalectomy (RPA) from June 2014 to October 2016
Surgical steps include: Incision of Gerota' s fascia at the level of the upper pole of the kidney and exposure of the adrenal gland; careful dissection of the medial aspect of the gland, preserving adrenal vessels with a selective control of vessels feeding the adrenal mass; progressive dissection of the mass with a pure enucleation technique in order to maximize the amount of adrenal parenchyma spared; specimen retrieval into an endocatch bag; hemostasis and closure of adrenal defect with a sliding clip technique.
Two cases are demonstrated in the video.
Baseline, perioperative and early functional outcomes data are reported.
All cases were completed robotically. Intraoperative blood loss was negligible, postoperative course was uneventful in all cases, except for 1 patient who required antibiotic therapy for post-operative fever (Clavien grade 2 complication). Median hospital stay was 3 days (IQR: 2-3).
Patients became normotensive immediately after surgery. Aldosterone and plasmatic renin activity levels returned within the normal range as well.
Robotic Partial Adrenalectomy is a safe and feasible technique.