Robot-assisted resection of retrocaval paraganglioma: technical considerations and approach

Here, we present the case of a 27-year-old male with a known history of Von Hippel Lindau (vHL) syndrome who was found to have a recurrent paraganglioma in the retrocaval space after laparoscopic right partial adrenalectomy at age 16. He was referred for consideration of a minimally invasive approach to resection. This is particularly important in vHL patients as they are at a high risk of recurrence and need for additional surgical interventions over the course of their lifetime. The paraganglioma measured 3.8 cm and was positioned within the retrocaval/aortocaval space, fully posterior to the left renal vein and abutting the right renal hilum. The accompanying video demonstrates a step-by-step approach to this challenging dissection, as well as pertinent preoperative planning, intraoperative positioning, port placement, and retraction techniques for optimal visualization. We also demonstrated the authors preferred approach to managing minor bleeding within the confines of a small space to salvage a minimally invasive resection. The robotic-assisted platform led to complete resection, uncomplicated hospital course, and discharge home on postoperative day one.