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Page 4 of 6 Naspro et al. Mini-invasive Surg 2021;5:50 https://dx.doi.org/10.20517/2574-1225.2021.77

Figure 3. Adrenal specimen.

treated with complete metastasectomy compared with those in which surgery was incomplete or omitted .
[7]
In the current paper, we present a very delayed onset of adrenal CRCC metastasis, 20 years after the removal
of primary tumor. We chose to avoid biopsy because of the double usefulness of surgery as diagnostic and
curative intent. Favorable predictors of survival after RCC metastasis resection are: (1) diagnosis to
[8]
occurrence of metastases > 1 year; (2) a unique metastatic site; and (3) age < 60 years . Our patient
presented with two out of three favorable characteristics. We planned to remove the adrenal mass with a
single site laparoscopic retroperitoneal approach in consideration of the shape, position, and previous
abdominal surgery.

Laparoscopic adrenalectomy was described for the first time in 1992 and has since become the most used
approach representing the gold-standard treatment for adrenal masses due to low perioperative morbidity
and low complication rates, offering reduced postoperative pain, length of stay, and recovery time [9-11] . The
following minimal invasive techniques have been described to approach the adrenal gland with laparoscopy
and robotics: transperitoneal or retroperitoneal via the anterior or lateral approach and single-port
transperitoneal or retroperitoneal. None of these techniques however have demonstrated a clear superiority,
highlighting the importance of the experience of the surgeon and center . Comparable safety and outcomes
[4]
have been demonstrated between transperitoneal and retroperitoneal laparoscopic approaches when
performed by trained and skillful surgeons [11-15] . The same is true for single-site laparoscopic surgery, where
the choices of the technique and of the approach are made by the surgeon according to his skills.