The giant cystic pheochromocytoma is a rare adrenal tumor in the predominantly asymptomatic course; so many cases are not diagnosed until the time of surgery. The simple mobilization of the tumor is associated with the passage to the blood of large amounts of catecholamines and high morbidity and mortality. So the surgery itself and perioperative management are a huge challenge due to there only a few cases report in the literature and there is no established protocol to the surgery.

We present a surgical video of a 63-year-old woman who presents to the emergency department with abdominal pain and palpation of a mass in the right hypochondrium that has been evolving for months. Emergency CT diagnosis reveals a solid-cystic mass measuring 17x24cm located in the right flank, with a possible adrenal origin, displacing adjacent structures (kidney, liver, and vein cava). Additional studies show elevated urine metanephrines (30,000)

Hospital admission under endocrinology for blood pressure control and alpha-adrenergic blockade with phenoxybenzamine, followed by surgical intervention. An open right adrenalectomy is performed, and a definitive pathological diagnosis of giant cystic pheochromocytoma is obtained.

The resection of the pheochromocytoma carries a high surgical and anesthetic risk, and presenting this clinical case will contribute to the literature on this topic for a reduction in the morbidity and mortality of these patients. Additionally, we provide the surgical technique performed in the operating room for large-sized pheochromocytomas that cannot be resected via laparoscopy.