Clinical case report: Treatment of Giant Adrenal Incidentaloma with Robotic Assisted Surgery in a Patient with Previous Laparotomy

Abstract

Introduction: An adrenal incidentaloma is a mass at the bilateral junction of the adrenal glands discovered incidentally during the investigation of another tumor or unrelated problems (1,3). The prevalence of these tumors ranges from 1 to 8%; and is more common in obese, diabetic and hypertensive patients [2,8]. Myelolipomas represent 10-15% of incidentalomas and according to their size and course the treatment and surgical approach may vary. Our case report describes a patient who presented with a "giant" adrenal myelolipoma that was managed by robotic adrenalectomy.

Objective: To describe a clinical case of robotic adrenalectomy for a giant incidentaloma of the adrenal gland in a patient with previous laparotomy.

Material and methods: Retrospective descriptive study presenting a clinical case.

Results: We present the case of a 38-year-old male patient with a IMC of 36 with a history of previous laparotomy due to abdominal trauma 10 years ago with the discovery of a giant incidentaloma of the right adrenal gland where adrenalectomy was performed by robotic-assisted surgery without complications during the intraoperative period and with a successful outcome.

Conclusions: The gold standard treatment for giant myelolipoma reported in several articles is laparotomic adrenalectomy. However, the improvements in both instrumentation and surgeons' experience and skills with laparoscopic and robotic surgery have allowed the minimally invasive approach to be used in more complex cases.

There is no consensus about which surgical technique is the best, however, the robotic approach is a safe strategy for giant adrenal masses and the surgeon should be able to decide the best approach for each case