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New England Section of the American Urological Association

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Robot-Assisted Laparoscopic Transdiaphragmatic Right Adrenalectomy
Robin Djang, MD, John Seigne, BCh, David Finley, MD.
Dartmouth Hitchcock Medical Center, Lebanon, NH.

Robot-Assisted Laparoscopic Transdiaphragmatic Right-sided Adrenalectomy: Technique and considerations
Background:
Multiple surgical approaches are available for consideration when an adrenalectomy is indicated by either open or laparoscopic means. We offer a video demonstration of a less utilized approach - a transdiaphragmatic adrenalectomy from a right sided approach with robotic assistance.
Methods:A 78 year-old male patient was found to have a solitary, biopsy-proven renal cancer metastasis to the right adrenal gland approximately nine years following right radical nephrectomy for T1bN0M0 grade 2 clear cell RCC. In the interim, he had undergone a large ventral hernia repair with placement of a large piece of intraabdominal mesh. Given the concerns for a hostile abdomen and retroperitoneum, the patient underwent a right sided adrenalectomy via a transdiaphragmatic approach with robotic assistance.
Results:The accompanying video illustrates the following principles; #1: Appropriate consideration of the various surgical approaches for an indicated adrenalectomy; #2: Patient positioning and port placement considerations; #3: Collaboration with anesthesiologists and thoracic surgeons comfortable with robotic surgical approaches; #4: The use of intraoperative ultrasound in guiding the surgical plan; #5: Consideration of the various helpful anatomic landmarks in the course of a transdiaphragmatic approach
Conclusion:The accompanying video illustrates the principles and considerations for a robotic-assisted laparoscopic transdiaphragmatic approach to a right-sided adrenalectomy. Collaboration with thoracic surgery colleagues as well as a thorough understanding of the thoracic and retroperitoneal anatomy is crucial to success in this less utilized approach.


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