Simultaneous robotic-assisted adrenalectomy and partial nephrectomy: technical aspects.

Robot-assisted partial nephrectomy has become a safe and feasible procedure for small renal masses (SRM). Similarly, robot-assisted adrenalectomy has also been well established. Robotic surgery has provided the possibility to manage complex cases that are considered technically challenging for traditional laparoscopy. We describe in this video the details of performing simultaneous robotic adrenalectomy with partial nephrectomy highlighting the technical aspects of the same. A 62-year-old gentleman presented to us with incidentally detected left renal complex cyst (Bosniak IIF) and a concomitant left adrenal mass. Hormonal evaluation of adrenal tumor revealed raised levels of serum estrogen and DHEAS. A robotic-assisted simultaneous procedure was planned. Patient was positioned in right lateral position. After port placement, robot was brought from the shoulder of the patient and docked. We first excised the adrenal tumor followed by the renal cyst. Total operative time was 180 min with warm ischemia time of 20 min for renal cyst excision. Drain was removed on post-operative day 2. Patient was discharged on post-operative day 3. Histopathology revealed adrenocortical adenoma and benign hemorrhagic renal cyst. We found simultaneous ipsilateral adrenalectomy with partial nephrectomy using robotic assistance is feasible and safe with minimal morbidity. Port placement in such cases should be individualized according to the location of the SRM. The robot provides the ergonomic advantage and 3D vision for better anatomic definition as compared to laparoscopy.