Robot-Assisted Laparoscopic Adrenal Metastasectomy With Prior Partial or Radical Nephrectomy: Step-by-Step Technique and 1-Year Outcomes

The purpose of this study was to elucidate the feasibility and safety of the technique of robot-assisted laparoscopic adrenal metastasectomy (RAL-AME) for adrenal metastasis (AM) originating from renal cell carcinoma (RCC) with surgical history. From October 2015 to September 2020, RAL-AME was performed on 13 patients with AM from RCC with surgical history by using a transperitoneal approach. Whether metastasis occurs on the left or right side, adhesiolysis is required in the supine position from the contralateral side to the affected side. Three planes were established sequentially to separate the AM with patients converted into a lateral decubitus position. The first dissection plane was between the inferior side of the liver for right AM or spleen for left AM and the posterior side of the colon. The second dissections plane was established between the anterior renal fascia and the lateral aspect of perirenal fat. Care should be taken to avoid damaging the aorta or inferior vena cava when establishing the left or right plane. The third dissection plane was achieved between the retrorenal fascia and the anterior aspect of the psoas major. The metastasis was identified and en bloc–excised. The median operative time was 127 minutes (range 60-290), and median estimated blood loss was 50 ml (range 20-500). The average time to oral intake and hospital length of stay were 2.5 and 2.8 days, respectively. Perioperative complications and conversion to open surgery were not observed. All surgical margins were negative. RAL-AME for adrenal metastasis is safe and feasible. The therapeutic effect and overall survival rate require further investigation with a larger sample size and longer follow-up.