Robotic Partial Adrenalectomy

Robotic Surgery for Functional Adrenal Tumors

Robotic partial adrenalectomy involves the surgical removal of a benign tumor from the adrenal gland while leaving the rest of the gland intact. The adrenal glands are two triangle-shaped organs that sit on top of the kidneys. They are responsible for producing a number of important hormones—substances that circulate throughout the bloodstream and help regulate blood pressure, sugar level, salt production and other metabolic functions. These hormones include cortisol, aldesterone, epinephrine (adrenaline), and norepinephrine. If an adrenal gland develops a benign functional tumor (so-called because it affects the way the gland functions) and begins producing too much of any one hormone, the tumor typically needs to be removed in order to avoid long-term health problems. While this sometimes requires removal of the entire adrenal gland—a procedure known as radical adrenalectomy—it's often possible to treat the condition by performing a partial adrenalectomy, thereby preserving function in the affected adrenal gland.

At the NYU Langone Robotic Surgery Center, we have pioneered and were the first to publish and describe robotic partial adrenalectomy. We are able to perform this advanced procedure largely due to the enhanced capabilities that the da Vinci Si surgical system provides to the operating surgeon, including improved precision of dissection, enhanced suturing capabilities, and the ability to import real-time ultrasound images into the console—all of which result in improved accuracy and less blood loss during surgery, and can often decrease the amount of time needed to perform the operation. At the same time, the minimally invasive nature of the robotic procedure means less post-operative discomfort and scarring and faster recovery for the patient.

How Robotic Partial Adrenalectomy is Performed

In this procedure, the patient is anesthesized and four ports are placed in the abdomen using quarter-inch incisions. The robot's 3-D, high-definition camera and three instrument arms are then inserted into the ports. The surgeon uses these instruments to expose and isolate the adrenal gland. Utilizing a laparoscopic ultrasound probe, real-time images are taken of the adrenal gland in order to identify the tumor and define its borders. Using a combination of monopolar scissors and bipolar cautery, the piece of the adrenal gland containing the tumor is then excised, and the cut edge is sutured closed to control bleeding.

Advantages of Robotic Partial Adrenalectomy

Less blood loss. A robotic partial adrenalectomy has the potential for significantly less blood loss during surgery, reducing the need for blood transfusions.
Less post-operative pain and scarring. The robotic procedure's small incisions avoid the need for a large, disfiguring scar, resulting in significantly less post-operative discomfort and minimal surface scarring.
Shorter hospital stay and faster recovery. Most patients undergoing robotic partial adrenalectomy leave the hospital in 1 to 3 days versus 4 to 5 days for open surgery, and are able to resume normal activities within 2 to 3 weeks, compared to 4 to 6 weeks for open surgery.
The greater precision and visualization offered by the da Vinci Si, plus its ability to overlay real-time ultrasound images on the image of the operating site, enhances the surgeon's ability to perform certain parts of the procedure—specifically the mapping out and excision of the tumor, and the reconstruction of the adrenal gland.

Robotic Partial Adrenalectomy at NYULMC

Surgeons at NYU Langone Medical Center were the first to describe and publish their technique on robotic partial adrenalectomy. When feasible and appropriate, this approach is our first choice in dealing with benign adrenal tumors. In certain instances, we'll also use this technique to manage malignant adrenal tumors—such as when a patient with only one adrenal gland has a single cancerous tumor in that gland.

Research by NYULMC Physicians on Robotic Partial Adrenalectomy

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