Introduction: Robotic assisted laparoscopic urologic surgery has only become more prevalent over the past two decades. The advent of the new single-port robotic platform has enabled surgeons to now perform traditional procedures through new approaches in hopes of decreasing pain, faster recovery, and improved cosmesis. While previous studies have demonstrated the feasibility of such surgery for adrenalectomies; we present here a case of a single port adrenalectomy via mini Pfannenstiel incision.
Methods: A 23-year old female with a 1 year history of amenorrhea was diagnosed with Cushing’s syndrome by her endocrinologist after complete endocrine workup. She ultimately was referred for surgical management after MR imaging demonstrated a 2.7cm left sided adrenal adenoma.
Results: With the patient positioned in a left modified flank position, surgical steps were similar to standard assisted laparoscopic adrenalectomy except for the observed more caudal vantage point given the orientation of the robotic trocar through the mini Pfannenstiel incision. The adrenal gland and tumor were resected in entirety and extracted using a 10mm EndoCatch bag. The patient was discharged post-operative day 3 with no complaints of pain with hydrocortisone and prednisone for one month. The pathology report was consistent with a 3.5cm adrenal cortical adenoma with negative margins.
Conclusions: We present here the feasibility of mini Pfannenstiel incision for single port upper tract urologic surgery. The robotic port placement through a mini Pfannenstiel incision provides a less visible incision which may be used for a variety of procedures. Care must be taken to avoid disorientation as this vantage point does have some alterations in tissue orientation when compared to standard port placement. With increasing prevalence of single-port robotic systems, surgeons should begin to imagine novel approaches for surgical cases in order to bring about the most ideal patient outcome.
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