Robotic adrenalectomy in the pediatric population: initial experience case series from a tertiary center
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CASE REPORT
Robotic adrenalectomy in the pediatric population: initial experience case series from a tertiary center Anirban P. Mitra1* , Evalynn Vasquez1,2, Paul Kokorowski1,2 and Andy Y. Chang1,2
Abstract Background: Laparoscopic resection is the most well described minimally-invasive approach for adrenalectomy. While it allows for improved cosmesis, faster recovery and decreased length of hospital stay compared with the open approach, instrument articulation limitations can hamper surgical dexterity in pediatric patients. Use of robotic assistance can greatly enhance operative field visualization and instrument control, and is in the early stages of adoption in academic centers for pediatric populations. Case presentation: We present a single-institution series of pediatric adrenalectomy cases. The da Vinci Xi surgical system was used to perform adrenalectomies on three consecutive patients (ages, 2–13 years) at our center. Final pathology revealed ganglioneuroblastoma (n = 2) and pheochromocytoma (n = 1). Median operating time was 244 min (range, 244–265 min); median blood loss was estimated at 100 ml (range, 15–175 ml). Specimens were delivered intact and all margins were negative. Median post-operative hospital stay was 2 days (range, 1–6 days). All patients remain disease-free at median follow-up of 19 months (range, 12–30 months). Conclusion: Our experience continues to evolve, and suggests that robotic surgery is safe, feasible and oncologically effective for resection of adrenal masses in well-selected pediatric patients. Keywords: Minimally-invasive surgery, Robotics, Pediatrics, Adrenal mass, Neuroblastoma, Pheochromocytoma, Case report Background While no randomized trials have evaluated the efficacy of open versus minimally-invasive surgery for treatment of solid abdominal tumors in pediatric populations, the minimally-invasive approach to adrenalectomy is a feasible alternative in well-selected patients [1, 2]. It offers the advantages of improved exposure, reduced soft tissue dissection, improved cosmesis, decreased morbidity and post-operative pain allowing for early feeding, faster return to activity, and decreased length of stay. In adults, *Correspondence: [email protected] 1 Institute of Urology, University of Southern California, Los Angeles, CA, USA Full list of author information is available at the end of the article
it has been associated with decreased blood loss and need for transfusion [3]. Laparoscopic adrenalectomy is the most extensively described minimally-invasive approach, but can be technically challenging due to the small intraabdominal spaces of pediatric patients, as well as limited instrument dexterity [4]. Use of robotic assistance allows the added advantages of magnified three-dimensional view and articulating instruments with increased range of motion, tremor control, which facilitate precise dissection and hemostasis. Robotic surgery has also been suggested to further reduce duration of hospital stay and blood loss compared to laparoscopic adrenalectom
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