Introduction

Partial adrenalectomy for functioning adrenal masses is significantly underused. Preliminary experiences suggested the effectiveness of partial adrenalectomy for functioning adrenal adenomas. _x000D_ We describe surgical technique and present perioperative and functional outcomes of a two center series including nine symptomatic aldosterone-secreting adenomas treated with robotic partial adrenalectomy (RPA)._x000D_

Methods

From June 2014 to October 2016 RPA was performed in 9 consecutive patients with symptomatic aldosterone-secreting adrenal adenomas._x000D_ Surgical steps include: Incision of Gerota' s fascia at the level of the upper pole of the kidney and exposure of the adrenal gland; careful dissection of the medial aspect of the gland, preserving adrenal vessels with a selective control of vessels feeding the adrenal mass; progressive dissection of the mass with a pure enucleation technique in order to maximize the amount of adrenal parenchyma spared; specimen retrieval into an endocatch bag; hemostasis and closure of adrenal defect with a sliding clip technique._x000D_ Two cases are demonstrated in the video._x000D_ Baseline, perioperative and early functional outcomes data are reported._x000D_

Results

All cases were completed robotically. Intraoperative blood loss was negligible, postoperative course was uneventful in all cases, except for 1 patient who required antibiotic therapy for post-operative fever (Clavien grade 2 complication). Median hospital stay was 3 days (IQR: 2-3)._x000D_ Patients became normotensive immediately after surgery. Aldosterone and plasmatic renin activity levels decreased and returned within the normal range after surgery as well._x000D_

Conclusions

Robotic Partial Adrenalectomy is a safe and feasible technique. Thanks to surgical skills acquired with partial nephrectomy, an increasing adoption of adrenal sparing surgery among minimally-invasive urologists is likely to be anticipated.

Funding

none