Articles

Surgery in Motion

Robot-Assisted Laparoscopic Partial Adrenalectomy for Pheochromocytoma: The National Cancer Institute Technique

By: Kevin P. Asher, Gopal N. Gupta, Ronald S. Boris, Peter A. Pinto, W. Marston Linehan and Gennady Bratslavskylowast

European Urology, Volume 60 Issue 1, July 2011, Pages 118-124

Published online: 01 July 2011

Keywords: Adrenalectomy, Laparoscopy, Partial adrenalectomy, Pheochromocytoma, Robotic surgery

Abstract Full Text Full Text PDF (829 KB)

Abstract

Background

Partial adrenalectomy has recently been advocated to preserve unaffected adrenal tissue during resection of pheochromocytoma.

Objective

To describe a robot-assisted laparoscopic partial adrenalectomy (RALPA) technique and to report on early functional and oncologic outcomes.

Design, setting, and participants

From 2007 to 2010, 15 RALPA were performed on 12 consecutive patients with pheochromocytoma. Follow-up data of >1 yr are available on 11 procedures. Median follow-up for the entire cohort was 17.3 mo (range: 6–45).

Surgical procedure

Positioning and port placement is designed for adequate reach and visualization of the upper retroperitoneum. The plane between the adrenal cortex and pheochromocytoma pseudocapsule is identified visually and with laparoscopic ultrasound. The tumor is dissected away from normal adrenal cortex, preserving normal adrenal tissue.

Measurements

Preoperative, perioperative, pathologic, and functional outcomes data were analyzed.

Results and limitations

Fourteen of 15 cases were completed robotically. Among 15 procedures, 4 were performed on a solitary adrenal gland. Four cases required resection of multiple tumors (up to six) with two performed in a solitary gland. The mean age of the patients was 30 yr, and the mean body mass index was 27. The mean operative time was 163min, the median estimated blood loss was 161ml, and the median tumor size was 2.7cm (range: 1.3–5.5). There was one conversion to an open procedure in a patient requiring reoperation on a solitary adrenal gland. One patient who underwent RALPA on a solitary adrenal gland required postoperative steroid supplementation at last follow-up. At a median follow-up of 17.3 mo (range: 6–45), there were no recurrences or metastatic events. Study limitations include small sample size and short follow-up.

Conclusions

RALPA for the treatment of pheochromocytoma is feasible and safe and provides encouraging functional and oncologic outcomes, even in patients with a solitary adrenal lesion or multiple ipsilateral lesions.

Take Home Message

Robot-assisted laparoscopic partial adrenalectomy is an emerging technique for treatment of adrenal pheochromocytoma. In addition to solitary lesions, the technique may be used for multifocal pheochromocytomas and lesions within solitary adrenal glands, with promising short-term functional and oncologic outcomes.

Keywords: Adrenalectomy, Laparoscopy, Partial adrenalectomy, Pheochromocytoma, Robotic surgery.

Footnotes

Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

lowast Corresponding author. Urologic Oncology Branch, National Cancer Institute, Building 10 Room 1-5940, Bethesda, MD 20892-1107, USA. Tel. +1 301 496 6353; Fax: +1 301 402 0922.

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