Keywords
Da Vinci Robotic System; Cushing’s Disease; Transabdominal Bilateral Adrenalectomy; Morbidly Obese; Super Obese; Minimally Invasive
Abstract
Introduction: Central obesity is a side effect of Cushing’s disease. Patients with pituitary-based tumors who have failed other surgical and medical treatments often face the option of bilateral end organ (adrenalectomy) removal.
Methods: In the past two years, four obese patients underwent robotic bilateral transabdominal adrenalectomy (RBTA) at our institution. One patient was obese (body mass index (BMI) 30.6 kg/m2 ), another was severely obese (BMI 37 kg/m2 ), another morbidly obese (BMI 40.4 kg/m2 ) and one was super-obese (BMI 53.2 kg/m2 )
Results: The operative times for the super obese, morbidly obese, severely obese and obese patients were 350, 310, 202 and 165 minutes, respectively. Removal of the left adrenal gland took longer (average 133 minutes) than right side (average 90 minutes). Blood loss was minimal (<25 mi). There was a minor liver laceration in the super obese patient. No other complications were observed at a median follow-up of IO months. The obese and severely obese patients were discharged post-op day 1 and 2; the morbidly and super obesepatients were discharged post-op day 4.
Conclusion: Despite the higher anesthetic risks, difficulties with positioning, thick abdominal walls and limited working space in obese patients, RBTA is a safe and effective method to remove the adrenal glands allowing this subset of patients the opportunity to undergo minimally invasive surgery.
Citation
Feng Z, Feng DP, Levine JW and Solorzano CC. Robotic Bilateral Transabdominal Adrenalectomy in Obese Patients. SM Min Inv Surg. 2017; 1(1): 1003.