Clinical application of robot-assisted laparoscopic resection of large pheochromocytomas via the renal surface plane using the fatty fissure as an anatomical landmark

Abstract

Objective: To evaluate the clinical utility of robot‐assisted laparoscopic resection for large pheochromocytomas via the renal surface plane, using the fatty fissure as an anatomical landmark.

Methodology: A retrospective study included 60 patients with large adrenal pheochromocytomas treated at The Affiliated Hospital of Hebei University (January 2023–December 2024), randomized into two groups (n=30 each). The study group underwent the landmark‐guided procedure, while the control group received conventional posterior retroperitoneal robot‐assisted laparoscopic surgery. Perioperative parameters (operation duration [DoO], intraoperative blood loss [IBL], drainage removal time [DRT], postoperative hospital stay [LoPHS]) and complications (intraoperative hemodynamic instability [IHDI], vasoactive agent use, ICU transfer rate, adrenal crisis, arrhythmia, stress ulcers) were compared.

Results: The study group showed significantly shorter DoO, LoPHS and DRT (P=0.00), lower IBL (P=0.00), reduced IHDI incidence, vasoactive agent use and ICU transfer rate (P<0.05 each), and a lower overall postoperative complication rate (P=0.04) versus the control group.

Conclusion: Fatty fissure‐guided robot‐assisted laparoscopic adrenalectomy via the renal surface plane improves anatomical guidance, reduces IBL, shortens operative and recovery time, and lowers complications for large pheochromocytomas, representing a safe, effective option for wider clinical use.