Introduction: Incidental adrenal masses are often benign and biopsy is not recommended. However, malignant potential exists in 6% of lesions >4cm and as high as 25% in lesions over 6cm, as a result surgical resection is recommended for masses over 5cm. Robotic resection today is considered standard of care, and the single port approach is novel and minimally described. In this video, we aim to review da Vinci single port (SP) access for left adrenalectomy via a McBurney incision as well as describe robotic instrument and assistant port configuration via the specialized da Vinci SP globe and demonstrate surgical technique for efficient and safe adrenal gland excision.
Methods: 59 year old male initially presented with left flank pain and CT imaging showed large left renal cysts as well as an incidental heterogenous 4.8cm x 3.9cm left adrenal mass with mixed attenuation. Full metabolic workup was normal. Surveillance MRI showed the mass to be >5cm and therefore patient elected for surgical resection. He underwent an SP left adrenalectomy in the right lateral decubitus position via a McBurney incision employing the specialized multi-access SP globe port, allowing for optimal dissection. We highlight efficient and judicious use of bipolar cautery in ligating the adrenal vein and excising out the adrenal gland.
Results: The patient tolerated the procedure well with a total operative time of 78 minutes and minimal blood loss. No intra-abdominal drain was placed, while a Foley catheter was removed 12 hours post operatively. The patient was discharged within 24 hours with no residual symptoms or complications at 90-day follow-up. The small single incision healed very well. Final pathology favored adrenal adenoma with a 4.2cm tumor and positive-free margins.
Conclusions: SP da Vinci robotic adrenalectomy with multi-access globe port is feasible and safe. The McBurney incision allows for efficient access to the renal hilum and avoids risk of midline hernia, while providing excellent cosmesis and minimal pain.
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