Bilateral posterior retroperitoneal robotic adrenalectomy for ACTH-independent Cushing syndrome

Laparoscopic posterior retroperitoneal (PR) adrenalectomy is preferable in patients with bilateral adrenal masses, as it obviates the need for repositioning. Robotic adrenalectomy has been reported to improve surgeon ergonomics and facilitate dissection. Although robotic bilateral transabdominal lateral adrenalectomy has been described in the literature, to our knowledge, the robotic bilateral PR approach has not been reported before. Herein, we report a case of a bilateral macronodular adrenal hyperplasia managed with robotic bilateral PR adrenalectomy.

A 60-year-old man was incidentally found to have bilateral macronodular adrenal masses on a computed tomography scan performed for abdominal pain. His laboratory workup was significant for adrenocorticotropic hormone-independent bilateral macronodular adrenal hyperplasia. He was consented for bilateral PR robotic adrenalectomy.

The procedure was performed robotically through a PR approach. Three robotic arms were used for the procedure on both sides using 5-mm instruments. Bilateral adrenalectomy was performed with a skin-to-skin operative time of 268 minutes (98 min for the left and 170 min for the right side). The patient was discharged on postoperative day 1 uneventfully on steroid supplementation. The final pathology revealed bilateral adrenal cortical hyperplasia.

To our knowledge, this is the first report of bilateral robotic PR adrenalectomy. This technique enables the resection of bilateral tumors without the need to reposition and may also provide potential advantages over laparoscopy, regarding the ease of dissection and surgeon ergonomics.