Robot-assisted posterior retroperitoneoscopic adrenalectomy

Minimally invasive adrenalectomy is the preferred surgical approach for small, benign adrenal neoplasms. Posterior retroperitoneoscopic adrenalectomy is associated with potential surgical advantages. We sought to investigate the feasibility and early outcomes for robot-assisted posterior adrenalectomy, which has not been previously reported.

Patients were selected for adrenalectomy based on standard clinical indications. The study was conducted under a protocol approved by the Institutional Review Board. Patients with adrenal masses larger than 7.0 cm, or with a body mass index (BMI) greater than 40, were excluded. Patient demographics, clinical and pathologic data, operative times, and patient outcomes were collected prospectively.

Six consecutive patients underwent robot-assisted posterior retroperitoneoscopic adrenalectomy (RAPRA) between June 23, 2009 and January 21, 2010. Five women and one man, ages 45 to 75 years (mean 55.5 years), with a mean BMI of 30, were included. There were three right adrenal tumors and three left adrenal tumors. Mean operative time was 121 minutes with a mean robot time of 57 minutes for the five patients in whom the entire adrenal dissection was performed robotically. There was essentially no morbidity and no mortality.

This study represents the first report of RAPRA, and demonstrates the feasibility of performing this procedure with good patient outcomes.