Pheochromocytoma is a rare catecholamine secreting neuroendocrine tumor. Adrenalectomy is the gold standard treatment of this tumor. Nowadays, a minimally invasive approach is demonstrated safe and effective for its treatment and it is routinely performed. The use of robotic technology can be useful especially in more difficult patients with larger adrenal tumors.

We present two cases of secreting symptomatic giant pheochromocytomas (diameter approximately 10 cm), undergone adrenalectomy with Da Vinci Robotic Surgical System (Intuitive Surgical), discussed in a multidisciplinary setting where a surgical operation was indicated and the patient was adequately prepared before surgery.

Robotic technique allowed us to highlight these giant lesions with no intraoperative complications, thanks to the three-dimensional vision of the operating field, the ergonomics of the surgical instruments and the smaller and more gentle manipulation of these hypersecreting lesions. In particular, it was easier to control the posterior bleeding in one of the cases and to clearly identify the usual landmark in the other one. The patient with the left lesion had a mild postoperative chylorrea, treated conservatively with lymphographic lipiodol injection into the left inguinal lymph nodes.

Robotic surgery can overcome the technical limitations of laparoscopic surgery for the treatment of the giant adrenal lesions and, nowadays, it represents a safe, comfortable and valid support for the surgeon. The treatment of giant hypersecretory adrenal lesions is complex and it requires a multidisciplinary approach in a high expertise for the management of the possible complications.