Posterior retroperitoneoscopic
adrenalectomy (PRA) is a minimally invasive procedure offering several advantages over a transabdominal laparoscopic operation. The three-dimensional optics and articulating instrumentation offered by current robotic surgical technology potentially improve this procedure. Robotic-assisted PRA (RA-PRA) was performed in patients meeting standard criteria for minimally invasive
adrenalectomy. We prospectively collected demographic, clinical, perioperative, and pathologic data on patients undergoing RA-PRA. Thirty consecutive RA-PRAs were performed in 28 patients (26 unilateral and 2 bilateral). Indications for
adrenalectomy included
pheochromocytoma (8),
hyperaldosteronism (3),
hypercortisolism (8), oligometastases (5), and nonfunctional
tumors (6). Mean
tumor size was 3.8 ± 1.6 cm. Mean body mass index was 30.7 ± 6.5 kg/m(2). Mean
operative time was 154 ± 43 minutes for unilateral total
adrenalectomy. Four patients with
multiple endocrine neoplasia Type 2A-associated
pheochromocytomas underwent cortical-preserving procedures. Three patients experienced perioperative complications (one
pneumothorax, one
urinary retention, one required postoperative
blood transfusion). No patient required
conversion to an open procedure. Robotic surgical technology is an excellent
complement to retroperitoneoscopic
adrenalectomy. The three-dimensional view and ergonomic advantages of a robotic procedure promote better visualization and a more flexible approach to dissection. We believe these features may optimize the ability to maintain a vascularized remnant during minimally invasive cortical-sparing
adrenalectomy.