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Bilateral posterior retroperitoneal robotic adrenalectomy for ACTH-independent Cushing syndrome.
[cushing syndrome]
Laparoscopic
posterior
retroperitoneal
(
PR
)
adrenalectomy
is
preferable
in
patients
with
bilateral
adrenal
masses
,
as
it
obviates
the
need
for
repositioning
.
Robotic
adrenalectomy
has
been
reported
to
improve
surgeon
ergonomics
and
facilitate
dissection
.
Although
robotic
bilateral
transabdominal
lateral
adrenalectomy
has
been
described
in
the
literature
,
to
our
knowledge
,
the
robotic
bilateral
PR
approach
has
not
been
reported
before
.
Herein
,
we
report
a
case
of
a
bilateral
macronodular
adrenal
hyperplasia
managed
with
robotic
bilateral
PR
adrenalectomy
.
A
60
-
year
-old
man
was
incidentally
found
to
have
bilateral
macronodular
adrenal
masses
on
a
computed
tomography
scan
performed
for
abdominal
pain
.
His
laboratory
workup
was
significant
for
adrenocorticotropic
hormone-independent
bilateral
macronodular
adrenal
hyperplasia
.
He
was
consented
for
bilateral
PR
robotic
adrenalectomy
.
The
procedure
was
performed
robotically
through
a
PR
approach
.
Three
robotic
arms
were
used
for
the
procedure
on
both
sides
using
5
-
mm
instruments
.
Bilateral
adrenalectomy
was
performed
with
a
skin
-
to
-
skin
operative
time
of
268
minutes
(
98
min
for
the
left
and
170
min
for
the
right
side
)
.
The
patient
was
discharged
on
postoperative
day
1
uneventfully
on
steroid
supplementation
.
The
final
pathology
revealed
bilateral
adrenal
cortical
hyperplasia
.
To
our
knowledge
,
this
is
the
first
report
of
bilateral
robotic
PR
adrenalectomy
.
This
technique
enables
the
resection
of
bilateral
tumors
without
the
need
to
reposition
and
may
also
provide
potential
advantages
over
laparoscopy
,
regarding
the
ease
of
dissection
and
surgeon
ergonomics
.
Diseases
Validation
Diseases presenting
"adrenocorticotropic hormone-independent bilateral macronodular adrenal hyperplasia"
symptom
cushing syndrome
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