5. DISCUSSION
Robotic-assisted laparoscopic technology offers significant advantages
over traditional open surgery and conventional laparoscopic surgery in
the resection of complex tumors[10], [11], such as those located
at the renal hilum. The robotic system provides high-definition, 3D
stereoscopic vision, which can magnify the surgical field more than 10
times, allowing for clearer visualization of critical anatomical
structures, such as the complex vasculature and surrounding tissues of
the renal hilum. Furthermore, robotic surgery reduces the physical
strain on surgeons, enabling long, high-precision procedures and
improving surgical efficiency[11]. Additionally, in partial
nephrectomy for renal tumors, robotics can optimize the balance between
tumor resection and renal function preservation, enhancing postoperative
renal function retention[12]. In the case reported here, the patient
had right renal atrophy and nonfunctional right kidney, necessitating
maximal preservation of the left renal unit. Although the tumor’s close
adhesion to the renal hilum vessels increased the surgical difficulty,
the superior ergonomics, 3D magnification of the surgical field, tremor
filtration, and enhanced instrument dexterity of the robotic-assisted
surgical system provided a significant advantage in handling complex
tumors surrounded by large blood vessels and tightly adhered to the
renal hilum. The tumor was successfully resected, with the kidney’s warm
ischemia time limited to only 20 minutes.
Adrenal function has long been suppressed by the high levels of cortisol
secreted by ectopic tumors[13]. Although the source of high cortisol
secretion is removed after surgery, adrenal function has not yet fully
recovered, and the patient remains in a relative state of cortisol
deficiency[13]. Therefore, glucocorticoid supplementation is
necessary after the removal of any cortisol-secreting tumor to prevent
symptoms of adrenal insufficiency or adrenal crisis[14]. Currently,
there is no standardized replacement therapy, and there are differences
in medication practices and experiences among medical centers.
Generally, hydrocortisone is administered intravenously during surgery
and on the day after surgery. Once oral intake is tolerated, prednisone
is switched to oral administration[14], [15]. Glucocorticoids
need to be gradually tapered because cortisol secretion follows a
diurnal and pulsatile rhythm in a physiological state. Thus,
glucocorticoid supplementation is given in multiple doses, with higher
doses in the morning and lower doses in the afternoon, and the dose may
be increased during times of stress[14].
Ectopic adrenal glands are rare in adults and are commonly located in
the retroperitoneal axis, broad ligament, or spermatic cord. Similar to
normal adrenal glands, they can develop cortical hyperplasia, nodules,
or adenomas. It is rare for ectopic adrenal adenomas to cause Cushing’s
syndrome. When the tumor is located near the renal hilum, the complex
anatomy increases the difficulty of complete resection. The use of a
robot-assisted surgical system allows for safer and more precise tumor
removal.