title: Robotic sequential right adrenalectomy and zero ischemia left partial nephrectomy in a patient with synchronous pheochromocytoma and renal cell carcinoma.
abstract: Currently, most renal masses are detected incidentally while still small in size because of the widespread use of radiological imaging, and most pheochromocytomas are localized in the adrenal glands as unilateral lesions. A 5 × 4-cm right adrenal mass and a 19 × 13-mm exophytic left renal mass were synchronously detected by contrast enhancement on computed tomography and magnetic resonance imaging in a 47-year-old male with hypertension. The patient's preoperative serum and 24-h urine catecholamine levels were elevated. Initially, robotic transperitoneal right adrenalectomy was performed, and histopathology confirmed a 4 cm pheochromocytoma. After 3 months, transperitoneal zero ischemia robotic left partial nephrectomy was performed, and histopathology demonstrated clear cell renal cell carcinoma, Fuhrman grade II, 17 mm in size with clear surgical margins. This case indicates that sequential robotic surgery is feasible and safe as a minimally invasive approach to remove bilateral renal and adrenal masses. Zero ischemia robotic partial nephrectomy is also feasible and safe for selected small renal masses.
authors.affiliation: Department of Urology, Yıldırım Beyazıt University Faculty of Medicine, Atatürk Training and Research Hospital, Ankara, Turkey.
authors.forename: Abdullah Erdem
authors.initials: AE
authors.lastname: Canda
authors.affiliation: Clinic of Urology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey.
authors.forename: Özer Ural
authors.initials: ÖU
authors.lastname: Çakıcı
authors.affiliation: Clinic of Urology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey.
authors.forename: Kemal
authors.initials: K
authors.lastname: Ener
authors.affiliation: Department of Urology, Yıldırım Beyazıt University Faculty of Medicine, Atatürk Training and Research Hospital, Ankara, Turkey.
authors.forename: Ali Fuat
authors.initials: AF
authors.lastname: Atmaca
keywords: Pheochromocytoma; renal cell carcinoma; robotic adrenalectomy; robotic partial nephrectomy; small renal mass; zero ischemia