Laparoscopic Left Adrenalectomy Research Articles

The Modified Semi-lateral Transmesocolic Approach for Laparoscopic Left Adrenalectomy.

As the most appropriate laparoscopic approach for adrenalectomy is still a matter of debate, we present a modified technique of laparoscopic transmesocolic approach for left adrenalectomy. All demographics, intraoperative and postoperative data of patients who underwent laparoscopic transmesocolic left adrenalectomy from 2009 to 2015 in Avicenne Hospital were recorded. Thirty-three consecutive patients underwent laparoscopic transmesocolic left adrenalectomy. We observed no conversion, negligible blood loss, no red cell transfusion or intraoperative complication. Mean operative time reached 96min (range: 40-200min). Postoperatively, the median length of hospital stay was 5days (range: 3-8days), mortality was nil, and six (19%) patients suffered from complication, including one major complication (Clavien-Dindo III-IV, an abdominal collection treated with radiologic drainage). R0 resection was achieved in all patients. Laparoscopic left adrenalectomy using semi-lateral transperitoneal transmesocolic approach is feasible and safe with acceptable intraoperative and perioperative outcomes. This technique could be considered as a routine approach and should be compared in further studies.

Synchronous renal cell carcinoma and pheochromocytoma presenting as acute decompensated heart failure

We report a 49-year-old woman who presented with a hypertensive crisis and acute heart failure and reduced left ventricular systolic function. An abdominal ultrasonography revealed a huge lobulated heterogeneous mass at the lower pole of the right kidney and a mass over the left suprarenal area, which were further delineated by magnetic resonance imaging. The patient underwent laparoscopic right radical nephrectomy and left adrenalectomy. Histopathological analysis confirmed the diagnoses of clear cell renal cell carcinoma of the right kidney with metastasis to the lung; and atypical pheochromocytoma of the left adrenal gland. Target therapy was initiated, which resulted in stabilization of the patient's tumors and the recovery of her heart function. To avoid a delayed diagnosis and catastrophic outcome, clinicians should consider such rare causes of acute decompensated heart failure.

Differential diagnosis of adrenal gland tumor: rare case report

With the advent of high-resolution research methods (CT, MRI), randomly detectable formations in the adrenal glands became a clinical problem. The incidence of incidental adrenal glands varies between studies. So, according to the latest data, IN is detected in about 4-5% of patients who underwent radiological imaging. A clinical observation of a 39-year-old patient with complaints of persistent increase in blood pressure is presented. In the course of a routine ultrasound of the kidneys, the formation of a left adrenal gland was revealed. According to the data of the subsequent examination (adrenal SCT with contrast, determination of the hormonal profile), adrenocortical cancer, a glucocorticoid producing, was diagnosed. The patient underwent surgical treatment in the volume of left laparoscopic adrenalectomy. However, according to the results of a postoperative histological and immunohistochemical study, pheochromocytoma was diagnosed. The patient was discharged in satisfactory condition under the supervision of an endocrinologist and a surgeon. This clinical observation demonstrates that the “ideal” diagnostic approaches for differential diagnosis of IN have not yet been developed. Therefore, the continuation of research aimed at improving the diagnostic algorithm, which makes it possible to more accurately determine the morphological nature of education and its hormonal activity at the preoperative stage, is relevant both in scientific and in practical terms.

Is laparoscopic left adrenalectomy with the anterior submesocolic approach for Conn's or Cushing's syndrome equally safe and effective as the lateral and anterior ones?

The aim of the present study is to report and to compare the results of three different laparoscopic transperitoneal surgical approaches [lateral transperitoneal (LT), anterior transperitoneal (AT) and anterior transperitoneal submesocolic (ATS)] for the treatment of Conn's and Cushing's syndrome from left adrenal disease. This study is a retrospective analysis of prospectively collected data. From 1994 to 2017, 535 laparoscopic adrenalectomies (LA) were performed. One hundred and sixty-four patients with Conn's or Cushing's syndrome underwent left LA. Patients were divided in three groups based on the approach: LT (Group A), AT (Group B) and ATS (Group C). The diagnosis was Conn's and Cushing's syndrome in 99 and 65 patients, respectively. LT was used in 13 cases, AT in 55 and ATS in 96. No significant differences in patient's gender, age and BMI were observed. Mean operative time was 117.6 ± 33.7, 107.6 ± 40.3 and 96.2 ± 47.5min for Groups A, B and C, respectively. Conversion to open surgery was observed in 4 Group C patients (4.1%). Morbidity occurred in 2 Group B (2%) and in 5 Group C patients (5.2%). In case of Conn's or Cushing's syndrome, left LA with ATS approach is equally safe and effective as compared to the LT and AT approaches. Early control of the adrenal vein with minimal gland manipulation and limited surgical dissection are the major advantages of the submesocolic approach. Even if statistically significant differences are not observed, postoperative results are the same as those reported in the literature with other approaches.

Multiple myeloma concealed by adrenal Cushing syndrome: a case report and review of the literature

BackgroundCushing syndrome coexisting with multiple myeloma has been previously described in a few reports. Overlapping clinical manifestations can lead to misdiagnoses.Case presentationWe presented an extremely rare case of a 33-year-old Thai woman with concomitant kappa light chain myeloma with adrenal Cushing syndrome, both of which were related to skeletal manifestations. A precedence report indicated that treatment of the Cushing syndrome could exacerbate the myeloma symptoms. Therefore, we were faced with the dilemma of which disease should be addressed first. We decided to treat our patient with a combination chemotherapy followed by an autologous stem cell transplant. Subsequently, a left laparoscopic adrenalectomy was successfully undertaken.ConclusionWe have reported the first association between adrenocorticotropic hormone-independent Cushing syndrome resulting from a left autonomous cortisol-secreting adrenal adenoma, and multiple myeloma.

V40 - Differences in laparoscopic right and left adrenalectomy outcomes, learning curve and efficacy of surgical experience to outcomes

V40 - Differences in laparoscopic right and left adrenalectomy outcomes, learning curve and efficacy of surgical experience to outcomes

Laparoscopic extended posterior sectorectomy for metastatic adrenocortical carcinoma: a minimally invasive approach to parenchymal preservation

Background: Parenchymal preservation contributes to improved morbidity and mortality after hepatic resection. Additionally, randomized data supports minimally invasive (MIS) approaches to hepatic resection, resulting in shortened hospitalization, reduced postoperative morbidity, and improved quality of life. The Wakabayashi complexity index for laparoscopic hepatectomy guides patient selection, but the combination of MIS and parenchymal preservation for complex hepatic resections is seldom performed. Methods: A 65-year old male with adrenocortical carcinoma was treated with a laparoscopic left adrenalectomy in 2012. Surveillance MRI 5 years later identified a new 1.7 cm lesion located adjacent to the right hepatic vein in segment 7 (Figure). Percutaneous biopsy was consistent with metastatic adrenocortical carcinoma. Given the prolonged disease-free interval, extended right posterior sectorectomy was recommended. Results: The patient was placed in a split leg French position. A 3-D laparoscope was used and 4 port sites were required. Taking advantage of patient anatomy, the right posterior hepatic artery and portal vein were ligated and divided within the porta hepatis. The translation of open parenchymal transection techniques with crush-clamping, energy, and staplers facilitated safe laparoscopic dissection between the anterior and posterior sectors, with control of intrahepatic vascular structures and ultimate division of the right hepatic vein at its origin. Conclusion: Parenchymal preservation leveraging MIS technique facilitated complete resection of an isolated adrenocortical carcinoma metastasis. Laparoscopic extended posterior sectorectomy allowed for rapid progression through postoperative milestones with early discharge and salvage of the majority of the anterior sector, thereby reducing this patient’s risk for postoperative liver failure and mortality.

Anesthetic Management of a Pacemaker With a Rate Drop Response Setting: A Case Report.

Permanent pacemakers are used for a variety of conditions and are commonly encountered in the perioperative period. This report describes the anesthetic management of a patient with a permanent pacemaker with a rate drop response (RDR) who presented for a laparoscopic left adrenalectomy. The RDR setting is a novel pacemaker mode often used in patients with a history of vasovagal syncope. There are no previous reports describing the anesthetic management of such a pacemaker. This case report describes the features of the RDR setting with the goal of educating clinicians who may encounter patients with this type of pacemaker. The patient described in this case report had large swings in blood pressure intraoperatively due to the natural function of his pacemaker. This report highlights the importance of understanding pacemaker modes in patients about to undergo surgery, especially because pacemaker functions are becoming increasingly sophisticated and more personalized to meet patients' specific needs.

Prikaz slučaja prve laparoskopske adrenalektomije kod feohromocitoma u Kliničkom centru Srbije

Introduction Endoscopic surgery progressed and developed significantly during the last two decades and laparoscopic adrenalectomy is now considered as the treatment of choice for pheochromocytoma. Still, this procedure can be associated with high incidence of intraoperative hypertension. We present a case of the first laparoscopic adrenalectomy for pheochromocytoma in Serbia. Case Outline A 55-year-old female was admitted to Center for surgery for pheochromocytoma of the left adrenal gland. Clinically patient acquires classical manifestation of pheochromocytoma (hypertension, palpitations, tachycardia and pain below the left rib cage). CT and MR revealed necrotic-cystic oval formation of the left adrenal gland, 50x48x48mm in diameter. The pre-operative preparation was with phenoxybenzamine, ACE inhibitors and rehydratation prior the surgery. Left laparoscopic adrenalectomy was performed with 3 ports (two 10-mm and one 5-mm ports). The anesthesia lasted 155 minutes and the operation 125 minutes. Regarding the blood pressure there were no hypertension crises during the surgery. The patient was discharged on the 3rd postoperative day to our endocrinology department, and during stay in our institution the patient was normotensive. Conclusion Laparoscopic adrenalectomy is the safe and effective surgical method for pheochromocytoma surgery.

Synchronous bilateral pheochromocytomas and paraganglioma with novel germline mutation in MAX: a case report

BackgroundRecent advance of genetic testing has contributed to the diagnosis of hereditary pheochromocytoma and paraganglioma (PPGL). The clinical characteristics of hereditary PPGL are varying among the types of mutational genes. It is still difficult to specify the pathognomonic symptoms in the case of rare genetic mutations. Here, we report the case of synchronous bilateral pheochromocytomas and paraganglioma with novel MYC associated factor X (MAX) gene mutation.Case presentationA 24-year-old female had hyperhidrosis and hypertension. Her urine test showed high normetanephrine and vanillylmandelic acid. Enhanced computed tomography revealed three enhanced masses in right adrenal gland, left adrenal gland, and left renal hilus. She was diagnosed with PPGL. Because 123I-metaiodobenzylguanidine scintigraphy indicated the accumulations in the left adrenal gland mass and the left renal hilus mass and not in the right adrenal gland mass, we performed laparoscopic left adrenalectomy and extirpation of the left renal hilus mass to preserve the right adrenocortical function. However, her symptoms recurred shortly after the operation presumably due to unveiling of the activity of the right pheochromocytoma. Following right adrenalectomy as the second operation, the catecholamine levels declined to normal range. Her genetic testing indicated the novel germline mutation in MAX gene (c.70_73 del AAAC/p.Lys24fs*40).ConclusionsMAX germline mutation is recently identified as a rare cause of hereditary PPGL. The deletion mutation in MAX gene in this patient has never reported before. In the case of bilateral pheochromocytomas, the surgical indication should be decided considering each patient’s genetic background. Due to the possibility for other types of malignant tumors, close follow-up is essential for MAX mutation carriers.

Laparoscopic transperitoneal adrenalectomy

To analyze the results of laparoscopic adrenalectomy (LAE) in patients with adrenal gland tumors. From 2011 to 2016, 24 patients (15 men, 9 women), mean age 49.6 +/- 8.2 years, underwent LAE. The right, left and bilateral LAE was performed in 12, 10 and 2 patients, respectively. Indications for surgery were mainly primary and metastatic adrenal tumors. The operations were performed using a transperitoneal 4-port approach. Twenty six LAE were successfully performed in 24 patients. There were no conversions. Blood transfusion was used only in 1 patient, who had a history of the laparoscopic left nephrectomy for the renal cell carcinoma 2 years earlier. She had bleeding due to a spleen injury during the left LAE. She also developed acute postoperative pancreatitis, resolved by conservative therapy. The mean intra- and postoperative blood loss was 160 (120-750) ml, the operative time was 135 (100-205) min, and the length of hospital stay was 4 (3-5) days. Histological examination revealed adenocarcinoma and adenoma in 20 (73.1%) and 6 (26.9%) removed adrenal glands, respectively. Laparoscopic adrenalectomy is an effective and safe surgical modality to treat patients with adrenal tumors.

Recurrent maxillary sinus cancer with only adrenal metastasis.

Maxillary sinus cancer is rare, and often presents as a locally advanced disease. Recurrence commonly occurs locoregionally, while fewer patients present with distant metastasis; the most common sites involved are the lung and bone. This report discusses the case of a 64-year-old male who presented with a mass in the left submandibular area. Biopsy was performed and histological analysis identified a poorly differentiated squamous cell carcinoma. After staging work up, it was concluded the patient had a maxillary sinus squamous cell carcinoma at clinical stage IVA. The patient received a left partial maxillectomy and left radical neck dissection followed by postoperative chemoradiotherapy. After three months of CRT, the patient developed a left adrenal gland metastasis without locoregional failure. The patient subsequently received a laparoscopic left adrenalectomy and the results of histological analysis revealed a poorly-differentiated squamous cell carcinoma. Within one month of surgery, the patient had developed multiple metastases at the left adrenalectomy site and succumbed to the disease four months later.

A case of Adrenocoricotrophic hormone -independent bilateral adrenocortical macronodular hyperplasia concomitant with primary aldosteronism

BackgroundAdrenocoricotrophic hormone (ACTH) – independent bilateral adrenocortical macronodular hyperplasia (AIMAH) is a rare cause of Cushing’s syndrome, and is characterized by bilateral adrenal hyperplasia. However, Primary aldosteronism (PA) is a relatively common adrenal disease.Case presentationA 56-year-old man who has been treated hypertension and diabetes mellitus was detected low plasma potassium level with an elevated level of plasma aldosterone concentration and bilateral adrenal swelling. Endocrinological examinations showed autonomous secretion of cortisol and aldosterone, with suppression of plasma ACTH level and renin activity. A selective adrenal venous sampling demonstrated that left adrenal gland was responsible for aldosterone hypersecretion. He was diagnosed preclinical Cushing’s syndrome due to ACTH – independent bilateral adrenocortical macronodular hyperplasia (AIMAH) associated with aldosterone producing adenoma of the left adrenal gland. A laparoscopic left adrenalectomy was performed.ConclusionThe resected adrenal specimen histologically consisted with a diagnosis of AIMAH. Moreover, tiny cell clusters positive immunostaining for aldosterone synthase was revealed. This is a rare case of AIMAH accompanied by preclinical Cushing’s syndrome and primary aldosteronism.

Single-stage laparoscopic adrenalectomy for pheochromocytoma and enucleation of a pancreatic neuroendocrine tumor in Von Hippel-Lindau disease: A case report.

Von Hippel-Lindau (VHL) disease is an inherited syndrome with autosomal-dominant transmission, characterized by central nervous system and retinal hemangioblastomas, visceral cysts and tumors. Optimal surgical treatment, including its timing, remains a controversial topic. The present study reports the case of a 67-year-old female patient with adrenal and pancreatic manifestations of VHL. A laparoscopic cortex-sparing left adrenalectomy for a 4-cm pheochromocytoma and pancreatic enucleation for pancreatic polypeptidoma of the pancreas tail were performed during the same operative procedure. The total operative time was 240 min. There were no operative complications, and the surgery was completed laparoscopically with minimal blood loss. A prolonged hospital stay was necessary to treat a grade C postoperative pancreatic fistula. The histopathological result was an adrenal pheochromocytoma and a well-differentiated neuroendocrine tumor, secreting pancreatic polypeptides. In conclusion, organ-sparing laparoscopic surgery is an important option for treating simultaneous lesions in several abdominal solid viscera, such as VHL disease, and the present case study represents, to the best of the authors' knowledge, the first report of single-stage laparoscopic adrenalectomy and pancreatic tumor enucleation.

Adrenal Intravascular Papillary Endothelial Hyperplasia

ABSTRACT Aim We describe the rare case of a woman with adrenal intravascular papillary endothelial hyperplasia (IPEH) or Masson's tumor. We present relevant background information on IPEH and our case report, as well as describe a workup and treatment plan for the lesion. Introduction Intravascular papillary endothelial hyperplasia (IPEH) or Masson's tumor is a rare lesion, i.e., predominantly found in the oral cavity, head, and neck.1-4 To our knowledge, only six adrenal IPEH cases have been reported in the literature to date.4 Case report A 49-year-old woman originally presented to us with an incidentaloma found on computed tomography scan. Due to the eventual size increase of the mass, a laparoscopic left adrenalectomy was performed. Pathologic evaluation of the mass revealed a 3 cm IPEH arising in a hemangioma within the adrenal gland. Conclusion Before the diagnosis of IPEH is considered as the etiology for an adrenal incidentaloma, it is crucial to rule out more common tumors. Serological and radiographic studies are critical to the workup. Clinical Significance: The IPEH is a very interesting lesion of the adrenal gland, however, it is exceedingly rare and thus exclusion of more common and serious lesions must be done prior to the diagnosis of IPEH. How to cite this article Holmes C, Akhras A, Schneider A, Yacoub JH, Picken M, Kabaker A. Adrenal Intravascular Papillary Endothelial Hyperplasia. World J Endoc Surg 2017;9(1):16-19.

Laparoscopic left and right adrenalectomy from an anterior approach - is there any difference? Outcomes in 176 consecutive patients.

IntroductionTraditionally, in open surgery, right adrenalectomy is considered technically more demanding than its left-sided counterpart. This belief is supposed to be attributable mainly to different anatomic characteristics of the adrenal veins. Whether this opinion is also correct for laparoscopic adrenalectomy remains elusive.AimTo compare the outcomes of left versus right laparoscopic adrenalectomy from an anterior approach.Material and methodsRetrospective statistical analysis of a prospectively compiled database of consecutive patients undergoing laparoscopic adrenalectomy in a single center with focus on potential differences in the left- versus right-sided procedure in terms of demographic parameters, tumor size, operating time, occurrence of serious intraoperative complications, conversion, length of hospital stay and re-operation rate.ResultsOne hundred seventy-six patients underwent elective laparoscopic adrenalectomy – 80 left-sided (45.45%) and 96 right-sided (54.55%). No significant difference was found between the groups in terms of age (54.09 ±11.2 vs. 56.27 ±11.6; p = 0.2), tumor size (3.39 ±1.86 vs. 3.26 ±1.66; p = 0.64), operating time (71.84 ±22.33 vs. 72.06 ±30.99; p = 0.95), occurrence of serious intraoperative complications (7.5% vs. 10.4%; p = 0.5), conversion (1.25% vs. 1.04%; p = 0.9), length of hospital stay (4.52 ±1.30 vs. 4.37 ±1.91; p = 0.55) or reoperation rate (5% vs. 1%; p = 0.11). There was no mortality.ConclusionsNo significant difference was found between the left and right laparoscopic adrenalectomy in terms of operating time, occurrence of serious intraoperative complications, conversion rate or postoperative outcome. Therefore, the opinion that the right-sided procedure is more difficult does not seem to be justified for laparoscopic adrenalectomy from the anterior approach.

PS 11-28 ADRENAL INSUFFICIENCY UNDER STANDARD DOSAGE OF POST-OPERATIVE GLUCOCORTICOID REPLACEMENT AFTER HEMI-LATERAL ADRENALECTOMY FOR CUSHING'S SYNDROME

Objective: The patients who have undergone hemi-lateral adrenalectomy for Cushing's syndrome become steroid-dependent. Therefore, sufficient replacement of glucocorticoid is needed in the post-operative period, though, determination of the adequate dosage for post-operative glucocorticoid replacement is difficult. Design and Method: A 62 year old Japanese woman presented hypertension 5 years ago and since then she showed loss of muscle strength and edematous face. Because facial edema, general fatigue, and muscle weakness were progressively worsened, she consulted us. Radiological examinations detected a 30 mm left adrenal mass. Endocrinological evaluations revealed an elevated urinary free cortisol (114 μg/day), without suppression of serum cortisol in midnight and with suppression of ACTH (<1.0 pg/ml) in the morning. After overnight 8 mg dexamethasone challenge, the serum cortisol level was maintained at 34.4 μg/dl and ACTH was <1.0 pg/ml. 131-IAdosterol scintigraphy revealed higher uptake in the left adrenal mass. Under a diagnosis of Cushing's syndrome due to left adrenal adenoma, laparoscopic left adrenalectomy was performed and 200 mg/day of hydrocortisone was administrated during peri-operative days. The dose was reduced gradually and she discharged with 30 mg/day of hydrocortisone. Results: She was transferred to emergency unit because of the symptoms of adrenal insufficiency on post-operative day 15. After an infusion of hydrocortisone 200 mg, the symptoms were immediately disappeared. The dose of hydrocortisone was slowly decreased under hospitalization; however, reduction of hydrocortisone lower than 60 mg/day was difficult because of nausea and fatigue. Hydrocortisone was gradually reduced and she discharged on post-operative day 92 at the dose of 30 mg/day. Conclusions: The glucocorticoid receptor would be down-regulated due to long-term exposure to excessive cortisol before surgery. Complicated heart failure was suggested to reduce absorption of hydrocortisone from intestine. In such cases, we should consider enough hydrocortisone administration with a dose of more than 30 mg/day to avoid adrenal insufficiency after surgery of Cushing's syndrome.

Adrenal Gland Under Pressure

A 74-year-old man was admitted for sudden onset of severe pain in the left thoraco-abdominal flank. He had no palpitations and no headache. Clinically, the patient presented diaphoresis and his systolic blood pressure was measured at 240 mmHg. He had a history of hypertension treated by metoprolol, hydrochlorothiazide, felodipin and quinapril. ECG showed only signs of left ventricular hypertrophy. Biology was normal except a slight renal impairment. Thoraco-abdominal computed tomography performed to exclude an aortic dissection revealed a huge left adrenal mass (80 mm) with a left perirenal hematoma. Patient was admitted in intensive care unit to control blood pressure. At that time, pheochromocytoma was clinically suspected. Repeated 24-hour urine fractionated metanephrines and catecholamines measurements showed elevation of normetanephrine and noradrenalin levels at 3.2- and 1.6-fold the upper limit of the normal range respectively (in 3 independent urine collections). Despite no clear cut-offs for urinary (nor) metanephrines values, we considered these increased levels as compatible with the diagnosis of pheochromocytoma. 18F-FDG PET/CT imaging showed an FDG-avid adrenal lesion without pathological uptake elsewhere. A laparoscopic left adrenalectomy was performed and pathological examination concluded to an infiltration of the adrenal gland by a clear-cell renal cell carcinoma. The present case focuses on the atypical presentation of a renal cell carcinoma. The adrenergic symptoms combined to the increased urinary normetanephrine levels suggested the diagnosis of pheochromocytoma but were probably related to catecholamines release caused by the hemorrhage of the renal cell carcinoma within the adrenal medulla.

Anesthetic Management of Clinically Silent Familial Pheochromocytoma with MEN 2A: A Report of Four Cases.

Familial pheochromocytomas are commonly associated with multiple endocrine neoplasia type 2 (MEN 2) syndrome. Majority of the patients present with normal clinical and biochemical parameters in the preoperative period, the incidence of hypertension being only 50%. Even though patients may be clinically asymptomatic, surveillance and proper preoperative evaluation is important, as surgery for associated tumors may precipitate a hypertensive crisis and result in severe complications. A family of 19 members, of which 12 were positive for MEN 2A syndrome, presented to our hospital. Seven of the 12 patients had pheochromocytoma and medullary thyroid carcinoma (MTC), while the other 5 had only raised plasma calcitonin levels. Two of the 7 patients presented with bilateral pheochromocytoma and underwent an open adrenalectomy. The other 5 patients had a left-sided adrenal tumor and underwent left laparoscopic adrenalectomy under combined general and epidural anesthesia. We present our experience with four of these five cases. We here state that how paucity of literature on perioperative preparation of clinically and biochemically silent pheochromocytomas led to serious intraoperative complications in one of four cases.

Laparoscopic Partial Adrenalectomy for the Management of Pheochromocytoma: A Case Report and Review of Literature

Introduction: Bilateral pheochromocytoma is a rare disease necessitating surgical intervention for adequate disease control. Laparoscopic adrenalectomy is the treatment of choice for adrenal tumor since 1991. Herein, we report a case of bilateral pheochromocytoma who received right robotic adrenalectomy previously. This time he received laparoscopic partial adrenalectomy for the treatment of left pheochromocytoma. Case Report: A 35-year-old man had hypertension and was under regular medication for 3 years. He had progressively poorly controlled pressure since 2012. Magnetic resonance imaging showed bilateral adrenal mass, in favor of bilateral pheochromocytoma (right: 3.5 × 2.0 × 1.9 cm, left: 3.0 × 2.7 × 3.8 cm). Hormonal profile examinations showed elevated urinary vanillylmandelic acid, epinephrine, norepinephrine, and dopamine. Robotic right adrenalectomy was performed in 2013. Pathology analysis showed right pheochromocytoma. Elevated urinary catecholamines level was noted after operation. Left laparoscopic partial adrenalectomy was performed in 2014. Total operative time was 120 minutes and total intraoperative blood loss was 30 mL. Convalescence was uneventful and the patient was discharged under stable condition. Postoperative prednisolone was given for 5 months. Normal hormone profile was noted 6 months after the operation. Discussion: Laparoscopic, including robot-assisted, partial adrenalectomy has been increasingly used recently. The main indications for partial adrenalectomy are solitary adrenal gland, bilateral disease, and patients with familial syndromes. Pheochromocytoma has been treated with partial adrenalectomy, especially in patients with von Hippel–Lindau syndrome, familial pheochromocytoma, or multiple endocrine neoplasia type IIA. According to previous series and reviews, laparoscopic partial adrenalectomy is a feasible procedure that provides good functional and oncologic outcomes for different types of adrenal lesions. Partial adrenalectomy provides similar surgical outcomes and perioperative complications to those reported for total adrenalectomy. Besides, partial adrenalectomy provides the benefits of independence from chronic steroid replacement and low-to-nonrecurrence rate. Addisonian crisis has been reported in as much as 35% of patients after bilateral adrenalectomy with a 3% mortality rate. These data strongly support that laparoscopic partial adrenalectomy is a feasible method for pheochromocytoma in patients with a solitary adrenal remnant. Conclusion: Laparoscopic partial adrenalectomy is a feasible method for patients with pheochromocytoma. No competing financial interests exist. Runtime of video: 10 mins