Robot-assisted radical adrenalectomy with clamping of the vena cava for excision of a metastatic adrenal vein thrombus: a case report.
BACKGROUND
Renal or adrenal neoplastic vein thrombi are relative contra-indications for laparoscopic treatment. To the best of our knowledge, we present the first robot-assisted radical adrenalectomy (RARA) with the presence of a thrombus in the adrenal vein.


METHODS
A 54 year-old male with a history of laparoscopic left radical nephrectomy for clear cell carcinoma was referred to our department with a diagnosed right adrenal tumour extending into the adrenal vein. A RARA was planned through a trans-peritoneal approach, and an en bloc resection of the adrenal and its vein with clamping of the vena cava was performed.


RESULTS
Console time was 94 min and the estimated blood loss was 44 ml. The pathology report confirmed clear cell carcinoma with negative surgical margins. Convalescence was uneventful.


CONCLUSIONS
RARA with thrombectomy and vascular reconstruction can be safe, effective and feasible in experienced hands, using robotic bulldogs.
Department of Urology, OLV Vattikuti Robotic Surgery Institute, Aalst, Belgium.
Achilles
A
Ploumidis
Department of Urology, OLV Vattikuti Robotic Surgery Institute, Aalst, Belgium.|Department of Urology, Ghent University Hopsital, Ghent, Belgium.
Anne-Françoise
AF
Spinoit
Department of Urology, OLV Vattikuti Robotic Surgery Institute, Aalst, Belgium.
Geert
G
De Naeyer
Department of Urology, OLV Vattikuti Robotic Surgery Institute, Aalst, Belgium.|Department of Experimental and Clinical Medical Sciences, Urologic Clinic, University of Padoua, Italy.
Vincenzo
V
Ficarra
Department of Urology, OLV Vattikuti Robotic Surgery Institute, Aalst, Belgium.
Alexandre
A
Mottrie
D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000556:secondary* / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D065287:Robotic Surgical Procedures / Q000379:methods*; D060205:Therapeutic Occlusion / Q000379:methods; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000473:pathology / Q000601:surgery*; D020246:Venous Thrombosis / Q000209:etiology / Q000473:pathology / Q000601:surgery*
adrenalectomy; robot; vein thrombus