Laparoscopic versus robotic adrenalectomy: A comprehensive meta-analysis

Economopoulos, Konstantinos P.; Mylonas, Konstantinos S.; Stamou, Aliki; Theocharidis, Vasileios; Sergentanis, Theodoros N.; Ψαλτοπούλου, Θεοδώρα; Richards, Melanie L.

doi:10.1016/j.ijsu.2016.12.118

Cited by 92 publications

(94 citation statements)

References 43 publications

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“…Nonetheless, malignant GNs remain extremely rare occurrences[ 21 ]. Ultimately, surgery constitutes the gold standard for the treatment of primary adrenal GNs[ 4 , 26 ]. Even though, laparoscopic adrenalectomy is usually the procedure of choice, a number of variables ( e.g ., hormonal activity, tumor location, and proximity to adjacent structures) also need to be taken into account when deciding on the best approach to operate on these rare tumors[ 24 ].…”

Section: Managementmentioning

confidence: 99%

Adrenal ganglioneuroma: What you need to know

Mylonas¹,

Schizas²,

Economopoulos³

2017

WJCC

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Adrenal ganglioneuromas (GNs) constitute rare, differentiated tumors which originate from neural crest cells. GNs are usually hormonally silent and tend to be discovered incidentally on imaging tests. Adrenalectomy is the gold standard for the treatment of primary adrenal GNs. Nevertheless, preoperative differential diagnosis of GNs remains extremely challenging, and thus histopathological examination is required in order to confirm the diagnosis of GN. Overall, prognosis after surgical resection seems to be excellent, without any recurrences or need for adjuvant therapy.

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Section: Managementmentioning

confidence: 99%

Adrenal ganglioneuroma: What you need to know

Mylonas¹,

Schizas²,

Economopoulos³

2017

WJCC

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“…Indeed, the robotic system is provided of stereoscopic 3D-magnified vision, additional degree of freedom by means of multi-articulated robotic arms with Endowrist technology, and a stable camera. Further, the natural hand tremor is eliminated and even the position is made more ergonomic, thanks to a comfortable sitting [12].…”

Section: Introductionmentioning

confidence: 99%

“…First, even for experienced laparoscopic surgeons, a significant learning curve is needed (about 20 cases) to obtain results comparable to the standard [13]. Moreover, due to the additional steps required, such as the docking of the robotic tower, a prolonged operative time is acknowledged [12,14]. Last but not least, the major drawback of the robotic surgery is represented by the elevated costs of the purchase and for the maintenance of the unit [15,16].…”

Section: Introductionmentioning

confidence: 99%

Robot-assisted adrenalectomy: state of the art

Materazzi

Rossi

2020

Updates Surg

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Currently, laparoscopic adrenalectomy is worldwide considered the gold standard technique. Both transperitoneal and retroperitoneal approaches have proved their efficacy with excellent outcomes. Since the introduction of da Vinci System (Intuitive Surgical, Sunnyvale, CA), robotic surgery has made many steps forward gaining progressively more diffusion in the field of general and endocrine surgery. The robotic technique offers advantages to overcome some laparoscopic shortcomings (rigid instruments, loss of 3D vision, unstable camera). Indeed, the robotic system is provided of stereoscopic 3D-magnified vision, additional degree of freedom, tremor-filtering technology and a stable camera. Recently, several case series have demonstrated the feasibility and the safety of robot-assisted adrenalectomy in high-volume centers with outcomes comparable to laparoscopic adrenalectomy. Notwithstanding, the technical advantages of the robotic system have not yet demonstrated significant improvements in terms of outcomes to undermine laparoscopic adrenalectomy. Moreover, robotic adrenalectomy harbor inherits drawbacks, such as longer operative time and elevated costs, that limit its use. In particular, the high cost associated with the use of the robotic system is primarily related to the purchase and the maintenance of the unit, the high instruments cost and the longer operative time. Notably, these aspects make robotic adrenalectomy up to 2.3 times more costly than laparoscopic adrenalectomy. This literature review summarizes the current available studies and provides an overview about the robotic scenario including applicability, technical details and surgical outcomes.

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“…As with most complex robotic procedures, we do anticipate that operative time will continue to improve as our experience matures. However, one is cautioned by findings from the adult population that indicate significantly longer operating time in patients who underwent robotic adrenalectomy when compared with those undergoing laparoscopic resection [10]. Median estimated blood loss was 100 ml (range, 15-175 ml).…”

Section: Discussionmentioning

confidence: 99%

Robotic adrenalectomy in the pediatric population: initial experience case series from a tertiary center

et al. 2020

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Background Laparoscopic resection is the most well described minimally-invasive approach for adrenalectomy. While it allows for improved cosmesis, faster recovery and decreased length of hospital stay compared with the open approach, instrument articulation limitations can hamper surgical dexterity in pediatric patients. Use of robotic assistance can greatly enhance operative field visualization and instrument control, and is in the early stages of adoption in academic centers for pediatric populations. Case presentation We present a single-institution series of pediatric adrenalectomy cases. The da Vinci Xi surgical system was used to perform adrenalectomies on three consecutive patients (ages, 2–13 years) at our center. Final pathology revealed ganglioneuroblastoma (n = 2) and pheochromocytoma (n = 1). Median operating time was 244 min (range, 244–265 min); median blood loss was estimated at 100 ml (range, 15–175 ml). Specimens were delivered intact and all margins were negative. Median post-operative hospital stay was 2 days (range, 1–6 days). All patients remain disease-free at median follow-up of 19 months (range, 12–30 months). Conclusion Our experience continues to evolve, and suggests that robotic surgery is safe, feasible and oncologically effective for resection of adrenal masses in well-selected pediatric patients.

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Laparoscopic versus robotic adrenalectomy: A comprehensive meta-analysis

Cited by 92 publications

References 43 publications

Adrenal ganglioneuroma: What you need to know

Adrenal ganglioneuroma: What you need to know

Robot-assisted adrenalectomy: state of the art

Robotic adrenalectomy in the pediatric population: initial experience case series from a tertiary center

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