Objective: Robotic adrenalectomy is one of the minimally invasive surgical methods gaining wide acceptance due to the three-dimensional imaging system and ergonomics of the equipment. We aimed to present the early data on patients who underwent robotic adrenalectomy due to adrenal masses in our hospital.
Material and Methods:The records of eight cases, in which a unilateral robotic trans-peritoneal adrenalectomy was conducted due to an adrenal mass between 2011 and 2013, have been evaluated. Demographic characteristics of cases, body mass index (BMI), American Society of Anesthesiologists (ASA) score, preoperative diagnosis, diameter and localization of the adrenal mass, operative time, blood loss, conversion rate to open surgery, morbidity and mortality rates, length of hospital stay, total hospital charges and postoperative pathologic results were considered.
Results:The female to male ratio was 6:2, the median age was 49.5 (26-71) and the median BMI was 29.7 (21.7-38.5). An adrenalectomy was performed in six cases for a right adrenal mass and in two cases for a left adrenal mass. The mean tumor diameter was 53.6 mm (20-90). The average surgical time (including docking) was 98 min. (55-175 min.) and the average blood loss was 50 mL. The only complication was a diaphragm injury which was repaired robotically. There were no conversions to traditional laparoscopic or open surgery and there have not been any mortality in the series. The median length of hospital stay was 4.1 days (range 2-11) and the average cost was 3617.12 TL ($1808.56).
Conclusion:Robotic adrenalectomy is an effective and safe surgical alternative to laparoscopic adrenalectomy. However its high cost has emerged as its main disadvantage.Key Words: Robotic adrenalectomy, minimally invasive surgery, laparoscopy, adrenal neoplasm
INTRODUCTIONAfter description of laparoscopic methods in adrenal surgery, the transperitoneal approach by Gagne (1) in 1992 and the retroperitoneal approach by Mercan (2), minimally invasive surgical techniques have been adopted, and evolution of these methods have continued with subsequent advances in technology.It has been shown that laparoscopic adrenalectomy (LA) results in less postoperative period pain and decreases the need for analgesics, as well as a shorter length of hospital stay, shorter operative time, less cost, and better cosmetic results as compared to open adrenalectomy (OA) (1-5). For these reasons, LA has become the current standard method of treatment.With the introduction of robotic surgery technology in many areas of surgery, the use of more ergonomic hand instruments, and the convenience they provided to the surgeon despite high costs, have made robotic adrenalectomy (RA) emerge as an alternative method to LA, and various RA techniques have been described (6, 7).In our hospital, daVinci ® SI robotic system is being used since 2009 (Figure 1), as until the end of 2012, 459 robotic surgeries have been performed, 41 of which were done by our General Surgery Clinics (Figures 2a and 2b). Most of the robot...