Robotic sequential right adrenalectomy and zero ischemia left partial nephrectomy in a patient with synchronous pheochromocytoma and renal cell carcinoma.

Currently, most renal masses are detected incidentally while still small in size because of the widespread use of radiological imaging, and most pheochromocytomas are localized in the adrenal glands as unilateral lesions. A 5 × 4-cm right adrenal mass and a 19 × 13-mm exophytic left renal mass were synchronously detected by contrast enhancement on computed tomography and magnetic resonance imaging in a 47-year-old male with hypertension. The patient's preoperative serum and 24-h urine catecholamine levels were elevated. Initially, robotic transperitoneal right adrenalectomy was performed, and histopathology confirmed a 4 cm pheochromocytoma. After 3 months, transperitoneal zero ischemia robotic left partial nephrectomy was performed, and histopathology demonstrated clear cell renal cell carcinoma, Fuhrman grade II, 17 mm in size with clear surgical margins. This case indicates that sequential robotic surgery is feasible and safe as a minimally invasive approach to remove bilateral renal and adrenal masses. Zero ischemia robotic partial nephrectomy is also feasible and safe for selected small renal masses.

[1]  A. Mottrie,et al.  Robot-assisted partial nephrectomy. , 2016, International journal of surgery.

[2]  J. Kaouk,et al.  Robot‐assisted partial nephrectomy with intracorporeal renal hypothermia using ice slush: step‐by‐step technique and matched comparison with warm ischaemia , 2016, BJU international.

[3]  Monish Aron,et al.  Robotic partial nephrectomy with superselective versus main artery clamping: a retrospective comparison. , 2014, European urology.

[4]  C. Giberti,et al.  Simultaneous bilateral robotic partial nephrectomy: Case report and critical evaluation of the technique. , 2014, World journal of clinical cases.

[5]  E. Berber,et al.  Bilateral Posterior Retroperitoneal Robotic Adrenalectomy for ACTH-independent Cushing Syndrome , 2014, Surgical laparoscopy, endoscopy & percutaneous techniques.

[6]  A. Canda,et al.  Robotic zero ischemia partial nephrectomy: step by step surgical technique with tips and tricks , 2014 .

[7]  Turgay Turan,et al.  İskemisiz Robotik Parsiyel Nefrektomi Mümkün mü , 2013 .

[8]  B. Gunlusoy,et al.  Changing Surgical Approaches for Laparoscopic Adrenalectomy: Single-Surgeon Data of a 6-Year Experience , 2013, Urologia Internationalis.

[9]  O. Sanli,et al.  The use of self-retaining barbed suture for inner layer renorrhaphy significantly reduces warm ischemia time in laparoscopic partial nephrectomy: outcomes of a matched-pair analysis. , 2013, Journal of endourology.

[10]  Inderbir S. Gill,et al.  Near‐infrared fluorescence imaging to facilitate super‐selective arterial clamping during zero‐ischaemia robotic partial nephrectomy , 2013, BJU international.

[11]  D. Balbay,et al.  Metachronous Periadrenal Fatty Tissue Metastasis from Contralateral Renal Cell Carcinoma , 2013, Case reports in urology.

[12]  E. Berber,et al.  Robotic Adrenalectomy , 2013, Cancer journal.

[13]  Dilek Berker,et al.  Transperitoneal laparoskopik adrenalektomi: Otuz beş hasta ile 5 yillik deneyimimiz , 2013 .

[14]  K. Rha,et al.  Initial Clinical Experience of Simultaneous Robot-Assisted Bilateral Partial Nephrectomy and Radical Prostatectomy , 2011, Yonsei medical journal.

[15]  Y. Ilbey,et al.  Transperitoneal versus retroperitoneal laparoscopic partial nephrectomy: initial experience. , 2011, Archivio Italiano di Urologia e Andrologia.

[16]  Benjamin R. Lee,et al.  Predictive value of R.E.N.A.L. nephrometry score in robotic assisted partial nephrectomy , 2011 .

[17]  A. Kural,et al.  Robot-assisted partial nephrectomy versus laparoscopic partial nephrectomy: comparison of outcomes. , 2009, Journal of endourology.

[18]  Monish Aron,et al.  Expanding indications for laparoscopic partial nephrectomy. , 2008, Urology.

[19]  P. Dasgupta,et al.  ROBOT‐ASSISTED PARTIAL NEPHRECTOMY , 2008, BJU international.

[20]  Z. Kırkalı,et al.  Open Partial Nephrectomy in the Management of Small Renal Masses , 2008, Advances in urology.

[21]  M. Menon,et al.  Synchronous Bilateral Adrenalectomy for Adrenocorticotropic-Dependent Cushing's Syndrome , 2008, JSLS : Journal of the Society of Laparoendoscopic Surgeons.

[22]  M. Mannelli,et al.  Pheochromocytoma in Italy: a multicentric retrospective study. , 1999, European journal of endocrinology.