Robotic retroperitoneoscopic adrenalectomy: useful modifications of the described posterior approach

Herein we describe a technique modification of the robotic posterior retroperitoneoscopic adrenalectomy (RPRA). Three patients presented to our clinic with adrenal lesions. The average BMI and tumor size was 29.3 kg/m² and 4.6 cm, respectively. All had prior major abdominal procedures. Long robotic trocars were used. A 5-mm assistant port was added and the number of robotic instrument use was minimized. The average total operation time was 136 min, average docking time was 14.7 min and the average console time was 108.7 min. Blood loss was minimal and there were no complications. In patients with prior history of extensive abdominal procedures, RPRA is safe and effective when performed by surgeons with PRA and robotic experience. Long robotic trocars effectively minimized external robotic arm collisions. Adding a 5-mm assistant trocar maximized the first assistant and console surgeon abilities. Limiting the number of robotic instruments and energy devices contained cost.