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. Conclusion RARA with thrombectomy and vascular reconstruction can be safe, effective and feasible in experienced hands, using robotic bulldogs