Single-Port Robotic Left Retroperitoneal Mass Excision of Paraganglioma

Abstract

Introduction:

A 44-year-old woman with a BMI of 49 presented to our clinic with a 2.6 cm left retroperitoneal mass. She had a 3-year history of headaches, flushing, anxiety, and uncontrolled blood pressure despite several antihypertensive medications. She underwent a metabolic work-up with a negative dexamethasone suppression test and elevated plasma metanephrine level (normetanephrine 2.83 nmol/L, which is more than twice the upper limit of normal). A Dotatate PET scan confirmed paraganglioma or pheochromocytoma in the left retroperitoneum. Upon referral to endocrinology, she was started on 2 mg of doxazosin daily, and 4 days later, was also given 25 mg of atenolol daily.

Materials and Methods:

After her blood pressure was controlled, she underwent an uncomplicated single-port robotic left retroperitoneal mass excision and adrenalectomy via modified supine anterior retroperitoneal access in flank position. ¹ Flank positioning was preferred over supine because, in our experience, in obese patients, supine is extremely challenging given the limited vertical strength and lift of the single-port robot. In order to pull the pannus away from the field and optimize visualization, the lateral decubitus position was utilized. Furthermore, as the patient’s blood pressure was not adequately decreasing until the adrenal vein was controlled, a decision was made to remove the adrenal vein. The total operative time was less than 3 hours (console time was 2.1 hours due to the challenging nature of the case), and the estimated blood loss was 20 cc. The patient was able to be discharged home the next day.

Results:

Pathology report demonstrated 2.5 cm paraganglioma and uninvolved adrenal gland.

Discussion:

Overall, this was found to be a functional paraganglioma that was intimately connected to the adrenal gland and adrenal vein. Paragangliomas are rare neuroendocrine tumors that originate from sympathetic or parasympathetic extra-adrenal autonomic paraganglia. As they are rarely malignant or metastatic, complete surgical resection is usually curative. ² Previous studies have described their experience using the single-port robot for adrenalectomy, ³ but to our knowledge, this is the first description of single-port robotic excision of paraganglioma.

Conclusion:

Excision of paraganglioma can be safely performed with single-port robot via a retroperitoneal approach.

Disclosure:

No conflict of interest from the source of the study. No commercial associations during the last 2 years that might create a conflict of interest in connection with the video.

Author(s) have received and archived patient consent for video recording/publication in advance of video recording of the procedure.

Runtime of video: 5 min 20 secs.