Robotic posterior retroperitoneal adrenalectomy: Operative technique

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.