Low Anterior Access Approach for Single-Port Retroperitoneal Robot-Assisted Adrenalectomy: Surgical Technique and...

The da Vinci single-port (SP) system has been utilized across various surgical procedures. However, a standardized technique for SP robot-assisted adrenalectomy (SP-RAA) remains unestablished. Herein, we report our technique for retroperitoneal SP-RAA via the low anterior access (LAA) approach.

Nine patients underwent SP-RAA using our standardized procedure. Patients were placed in a modified supine position. The primary incision was typically located two fingerbreadths cranial to a point two-thirds laterally along the spino-umbilical line. The operation was performed via a retroperitoneal approach. For right-sided tumors, dissection proceeded cranially along the psoas muscle and the inferior vena cava. For left-sided tumors, a gonadal vein-guided ascending approach was utilized to clear the surgical plane. After identifying and transecting the adrenal vein, periadrenal dissection was performed, and the adrenal gland was dissected free from its retroperitoneal attachments. Median operative and console times were 128 and 91 min, respectively, with no perioperative or postoperative complications or readmissions occurring within 30 days.

Although surgeons require familiarization with this unique approach and the corresponding orientation of anatomical structures, the LAA approach can be successfully utilized for SP-RAA. It may enhance safety over traditional methods, including prone or transperitoneal approaches, by avoiding forced positioning and mitigating the risks associated with intraperitoneal manipulation.