Robotic Approach to Surgery for Pheochromocytoma in Children: A Case Series

Pheochromocytoma is a rare disease in children with incidence of reported as 1 in 10 million children. There are few reported series with clinical follow-up published in literature from the Indian subcontinent; none has reported minimally invasive operation for pheochromocytoma and long-term outcome. These children present with symptoms secondary to increased catecholamine secretion from the adrenal pheochromocytes, of which hypertension is the most common and can be life threatening. Although hypertension in children is almost always secondary to a hidden disease, children with pheochromocytoma may be treated for a while before diagnosis is established. Surgical excision of the tumor is the treatment. Preoperative assessment can be challenging as 10% of the cases may be syndromic with bilateral tumors and associated with multiple endocrine neoplasia. The preoperative stabilization of the child with alpha antagonists, fluid replacement, and beta-blockers are the mainstay of preoperative preparation. Intraoperative disasters are well known in the absence of adequate preparation. Conventional procedure has been the standard surgical approach. Minimally invasive surgery (MIS) in children for pheochromocytoma is evolving. We report a series of five children treated over 5 years by the minimally invasive approach with follow-up details for this period. This study confirms the efficacy of MIS approach in treatment of pheochromocytoma and its ability to produce reliable results in the long term.