Abstract
Clinical History:
A 78-year-old male with a history of right clear cell renal cell carcinoma (RCC) with open flank radical nephrectomy 10 years ago, newly found to have a 6.0 cm right adrenal mass concerning for recurrence with concurrent adrenal vein tumor thrombus. Resection of adrenal tumor with venous tumor thrombus poses a unique surgical challenge, and there are limited reports of using both minimally invasive surgery and single incision approaches.
Physical Examination:
Right adrenal tumor was measured 4.5 × 4.0 × 6.0 cm3 in size on cross-sectional MRI. The mass appeared to be abutting the hepatic capsule and the inferior vena cava (IVC). There was no clear evidence of thrombus on preoperative imaging.
Diagnosis:
Percutaneous biopsy confirmed clear cell (Grade 2) RCC of the right adrenal gland. Staging workup revealed a separate 2.2 cm posterior mediastinal mass that was biopsy proven to be a schwannoma. No other metastatic lesions were identified.
Intervention:
Right adrenal tumor was resected en bloc with adrenal vein thrombus via a single-port extraperitoneal robotic approach. Intraoperative ultrasound confirmed the presence of adrenal vein thrombus and delineated the proximal relationship to the IVC. Concurrent adrenal vein thrombectomy and closure of the adrenal vein at the IVC junction were performed.
Follow-Up/Outcomes:
Final pathology revealed grade 3 clear cell RCC with negative resection margins (including proximal adrenal vein margin). This video demonstrates the feasibility and surgical technique of single-port robotic resection of an adrenal tumor with adrenal vein tumor thrombus and primary venous repair.
Patient Consent Statement:
Informed consent was obtained from the patient for the use of medical information, images, and/or video in this abstract submission. All identifying details have been removed to ensure patient confidentiality in accordance with institutional and ethical guidelines.
Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.
No competing financial interests exist.
Source of Study: None.
Research Funding or Support to Institution: Pfizer, BMS, Anchiano Therapeutics, QED Therapeutics, Merck, CoImmune, UroGen, enGene, Photocure, Janssen, ProTARA, CG and Oncology.
Consulting: Pfizer (2022–2025), Intuitive Surgical (Proctor, 2019, 2023), GNE/Roche (2017), and AstraZeneca (2024–2025).
Stock: None.
Honoraria/Travel: None.
Runtime of video:
5 mins.
Keywords