Robot-assisted left adrenalectomy with left renal vein tumor thrombectomy
INTRODUCTION: we highlight surgical steps of a left adrenalectomy and left renal vein tumor thrombectomy.
METHODS: preoperative CT scan highlights a 7 cm left adrenal mass with a tumor thrombus extending into the left renal vein. Left renal vein was prepared and encircled with tourniquet distally to the renal vein branch. After left renal artery identification, left renal vein was furtherly prepared and a tourniquet was placed proximally to the left renal vein branch. Left adrenal vein was hence isolated and encircled with tourniquet. Left renal vein and left adrenal vein tourniquets were cinched down and a renal vein was incised and the thrombus meticulously removed, in conjunction with the adrenal vein ostium. Left adrenal vein was stapled and the specimen secured into an endocatch bag. The left renal vein was sutured and all tourniquets removed, without any blood leakage. The adrenal mass was then progressively dissected and secured in an endobag.
RESULTS: Operative time was 170 minutes. Perioperative course was uneventful and patient was discharged in postoperative day 5. The pathologic report showed a primary adrenocortical carcinoma. Post operative CT scan was negative.
CONCLUSIONS: robot-assisted left adrenalectomy with left renal vein tumor thrombectomy is a feasible and safe treatment option in a tertiary referral center, with favourable perioperative outcomes.