Robot-assisted adrenal-sparing surgery for pheochromocytoma: Initial experience

Purpose: To assess the feasibility, describe the technique, and report our experience with use of the da Vinci S robotic surgical system in the management of pheochromocytoma. Patients and Methods: For four patients with metabolically active adrenal pheochromocytoma (two right, two left), standard preoperative preparation was performed. A robotic transperitoneal approach was used for all cases. Sparing of the adjacent normal parenchyma was performed in all cases. All relevant perioperative details were collected and analyzed. Results: Mean operative time was 77.5 minutes (range 40-140min), and blood loss was 97.5mL (range 50-160mL). There were no conversions or perioperative complications. Average tumor size was 4.7cm. There were three episodes of intraoperative hypertension necessitating therapeutic intervention. Average analgesic requirement was 150mg of diclofenac, and patients were allowed oral intake after 6 hours. The drain was removed within 24 hours, with average hospital stay of 4 days. The histopathology report confirmed pheochromocytoma in all patients with free surgical resection margins. Average follow-up was 9 months (range 4-14 mos) with no evidence of recurrence or extra-adrenal tumor. Conclusion: Robot-assisted excision of pheochromocytoma is feasible, safe, and efficacious in our early experience. Sparing of the normal adjacent adrenal parenchyma is possible with little detrimental effect on the oncologic efficacy of the surgery. Long-term studies are needed to further confirm this issue.