Robotic Assisted Right Adrenalectomy with IVC Thrombectomy

Introduction & Objectives: We are presenting a rare case of robotic assisted right adrenalectomy with level-II Inferior vena cava thrombectomy (RAIVCT) in right adrenal tumor with inferior vena cava (IVC) thrombus. Level-II RAIVCT sometimes requires suprahepatic IVC control or cutting of short hepatic veins.

Materials & methods:

58 year old diabetic and obese male was incidentally diagnosed with right adrenal mass. On further evaluation with MRI, adrenal mass had loss of fat planes with right lobe of liver and level II IVC thrombus. He underwent robotic assisted right adrenalectomy with level II IVC thrombectomy with suprahepatic IVC control. First in supine position, after port placements and docking, robotic hepatic surgeon performed liver lobe mobilization, supra-hepatic IVC and porta hepatis looping. Then changed to right flank up position with re-docking of ports. Hepatic surgeon performed short hepatic veins ligation followed by right adrenalectomy, IVC Thrombectomy by uro-surgeon. Robotic system was utilized.

Results & Observations:

Intra-operative: IVC clamp time-11 minutes, console time-201 minutes, adrenalectomy and IVC Thrombectomy time-86 minutes, [porta hepatis and supra-hepatic IVC were not clamped], total operative time- 313 minutes, Blood loss-70 ml, no drain kept, no complications. Patient was discharged on day-4. Histopathology report was PT4N0M0, low grade adrenocortical carcinoma with IVC thrombus free of tumor. Patient is doing well on follow up without any recurrence or metastasis.

Conclusions: Complex surgical procedure like adrenalectomy with level II IVC thrombectomy is better done by robotic than other with better surgical outcomes with added advantages of less pain, earlier recovery and better cosmesis.