AB027. SOH22ABS148. Robotic adrenalectomy for a complex case of clinically malignant phaeochromocytoma with large retroperitoneal haemorrhage: operative technique with a dual-console Xi da Vinci surgical system

Background: Phaeochromocytomas are rare, catecholamine secreting tumours which pose significant challenges during the peri-operative period, particularly intraoperative management. Adrenalectomy is the gold standard treatment. Open adrenalectomy has significant morbidity. This can be minimised with the use of minimally invasive surgery. We aim to describe our technique of robotic adrenalectomy (RA) in a complex case of clinically malignant phaeochromocytoma complicated by large retroperitoneal haemorrhage.

Methods: A 74-year-old gentleman with a background of obesity, dyslipidaemia and hypertension presented to the emergency department with acute severe right flank pain and hypotension. Imaging identified a large retroperitoneal haemorrhage related to an 8 cm enhancing mass arising from the right adrenal gland. Biochemical studies showed metabolically active noradrenaline dominant phaeochromocytoma. Discussion at multi-disciplinary meeting raised the possibility of malignant phaeochromocytoma. He was optimised with multidisciplinary team (MDT). He then underwent right RA. We describe operative details and technique in our video.

Results: Following general anaesthesia the patient was positioned into left lateral-decubitus position without table flexion. Intra-operatively we encountered extensive adhesions of the adrenal tumour with surrounding tissues including inferior vena cava, liver, diaphragm and posterior abdominal wall; likely secondary to extensive retroperitoneal haemorrhage. En-block adrenalectomy was performed with the use of da Vinci dual console robotic platform. There were no intra-operative or post-operative complications. Console time was 180 minutes. Blood loss was 150 mL. Patient was dischargeable day 2 post-op but went home day 3 post-operatively.

Conclusions: With the help of MDT, RA can be safely performed with an excellent outcome, even in the complex situation of potentially malignant phaeochromocytoma.

Keywords: Adrenalectomy; multidisciplinary team (MDT); minimally invasive surgery; phaeochromocytoma; robotic