Using Mcburney's Incision for a Single Port Da Vinci Robotic Adrenalectomy and Simple Nephrectomy

Author Type(s)

Resident/Fellow

Document Type

Abstract

Publication Date

2022

DOI

10.1089/end.2022.36001.abstracts

Journal Title

Journal of Endourology

Department

Urology

Abstract

Introduction &Objective: Laparoscopic adrenalectomy was first described in 1992. A minimally invasive approach is the standard of care in benign adrenal disease and is increasingly used in adrenal malignancies. Robotic assisted laparoscopic surgery has greatly improved the technique by expanding the range of motion in a 3D environment. In 2018, the single port robotic system has further enabled advances in minimally invasive surgery. However, there is a higher learning curve to adopting single port robotics due to the physical limitations of operating multiple instruments in close proximity. There remains a paucity of educational videos on how to perform single port surgery, including in adrenal disease. We aim to demonstrate a single port right adrenalectomy and simple nephrectomy. We describe a novel and simple approach using the McBurney's incision to gain transperitoneal access to the adrenal gland and kidney. Methods: This is a 33 year old female with refractory hypertension. Workup revealed a right adrenal aldosteronoma and an atrophic multicystic kidney. Due to the poor functioning ipsilateral kidney, she underwent a simultaneous single port robotic right adrenalectomy and simple right nephrectomy. Results: The right adrenal gland and involuted kidney were removed en bloc in an efficient and safe manner. The total operative time was 60 minutes and the estimated blood loss was less than 10 mL. No drains were required. The patient's pain was minimal and she was discharged on the same day as surgery. The incision healed with excellent cosmetic results. No surgical site infections, incisional hernias or other postoperative complications were noted. Final pathology confirmed an adrenal gland with cortical hyperplasia and a multicystic dysplastic kidney. Conclusions: A simultaneous single port robotic right adrenalectomy and simple nephrectomy is a safe and feasible technique when performed by an experienced surgeon. The McBurney's incision is a novel approach that provides excellent access and visualization. A distinct advantage is the improved cosmesis and reduced risk for midline hernias. Additionally, there is the potential for reduced post-operative pain which may enable more same day discharges. Further refinement of the technique will hopefully add to the urologists' armamentarium against surgical adrenal disease.

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