Perioperative outcomes of robotic and laparoscopic adrenalectomy: a large international multicenter experience

Sforza, Simone; Minervini, Andrea; Tellini, Riccardo; Ji, Changwei; Bergamini, Carlo; Giordano, Alessio; Lü, Qun; Chen, Wei; Zhang, Feifei; Ji, Hao; Maida, Fabrizio Di; Prosperi, Paolo; Masieri, Lorenzo; Carini, Marco; Valeri, Andrea; H, Guo

doi:10.1007/s00464-020-07578-5

Cited by 24 publications

(19 citation statements)

References 19 publications

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“…Similarly to the majority of studies on this topic [23,24,34,[47][48][49][50][51][52][53][54], our experience confirms that robot-assisted adrenalectomy is a safe technique with acceptable perioperative complications rate.…”

Section: Discussionsupporting

confidence: 84%

Robot-assisted vs laparoscopic lateral transabdominal adrenalectomy: a propensity score matching analysis

et al. 2022

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Background Laparoscopic adrenalectomy (LA) is the gold standard treatment for adrenal lesions. Robot-assisted adrenalectomy (RAA) is a safe approach, associated with higher costs in absence of clear-cut benefits. Several series reported some advantages of RAA over LA in challenging cases, but definitive conclusions are lacking. We evaluated the cost effectiveness and outcomes of robotic (R-LTA) and laparoscopic (L-LTA) approach for lateral transabdominal adrenalectomy in a high-volume center. Methods Among 356 minimally invasive adrenalectomies (January 2012–August 2021), 286 were performed with a lateral transabdominal approach: 191 L-LTA and 95 R-LTA. The R-LTA and L-LTA patients were matched for lesion side and size, hormone secretion, and BMI with propensity score matching (PSM) analysis. Postoperative complications, operative time (OT), postoperative stay (POS), and costs were compared. Results PSM analysis identified 184 patients, 92 in R-LTA and 92 in L-LTA group. The two groups were well matched. The median lesion size was 4 cm in both groups (p = 0.533). Hormonal hypersecretion was detected in 55 and 54 patients of R-LTA and L-LTA group, respectively (p = 1). Median OT was significantly longer in R-LTA group (90.0 vs 65.0 min) (p < 0.001). No conversion was registered. Median POS was similar (4.0 vs 3.0 days in the R-LTA and L-LTA) (p = 0.467). No difference in postoperative complications was found (p = 1). The cost margin analysis showed a positive income for both procedures (3137 vs 3968 € for R-LTA and L-LTA). In the multiple logistic regression analysis, independent risk factors for postoperative complications were hypercortisolism (OR = 3.926, p = 0.049) and OT > 75 min (OR = 8.177, p = 0.048). Conclusions The postoperative outcomes of R-LTA and L-TLA were similar in our experience. Despite the higher cost, RAA appears to be cost effective and economically sustainable in a high-volume center (60 adrenalectomies/year), especially if performed in challenging cases, including patients with large (> 6 cm) and/or functioning tumors. Graphical abstract

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Section: Discussionsupporting

confidence: 84%

Robot-assisted vs laparoscopic lateral transabdominal adrenalectomy: a propensity score matching analysis

et al. 2022

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“…In our study, we analyzed the tumor size ⩾6 cm between LA versus RA and found concordance results with the previous study. Moreover, Sforza et al 24 reported that the only independent predictor of surgical complication was the size of the tumor >6 cm. However, the present study did not show a statistically significant difference in terms of tumor size.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, Sforza et al 24 reported that the only independent predictor of surgical complication was the size of the tumor >6 cm. However, the present study did not show a statistically significant difference in terms of tumor size.…”

Section: Discussionmentioning

confidence: 99%

Robot assisted laparoscopic adrenalectomy: Should this be the new standard?

Selvaraj¹,

Pooleri

Addla

et al. 2022

Urologia

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Introduction: Minimal invasive surgeries (MIS) for large size adrenal tumors are still debatable. The objective is to evaluate the contemporary peri- and post-operative outcomes of patients undergoing (open = OA, laparoscopic = LA, and robotic = RA) adrenalectomies in three institutions. Materials and methods: Retrospectively gathered peri- and post-operative data of 235 patients, underwent adrenalectomy at three Institutions over a 7-year period (2013–2020) were analyzed. All patients underwent thorough radiological and endocrine workup. Results: Two hundred and thirty five patients who underwent adrenalectomy (OA ( n = 29), LA ( n = 146), and RA ( n = 60)) were assessed. OA ( n = 29) versus Minimally invasive surgery ( n = 206) showed significant differences (median, p value) in larger tumour size, cm (9.4 vs 5, ( p = 0.0001)), longer operative time, mins (240 vs 100, ( p = 0.0001)), longer hospital stay, days (8 vs 3,( p = .0001)), Higher readmission rates (14% vs 1.9%), higher blood loss, ml (400 vs 100, ( p = 0.0001)) requiring blood transfusion (14% vs 4.3%) ( p = 0.03), higher intraoperative complication (21% vs 6%) ( p = 0.0004), and post op complications (17% vs 5.3%) ( p = 0.01). Amongst the MIS (RA vs LA), RA appeared be have better outcomes in terms of shorter operative time, less blood loss and less intra operative complications with a p value <0.05. These results were consistent for the assessment of patients who had ⩾6 cm tumor size. The postoperative complication rates were lowest with RA (3.3%) compared to OA (17%) and LA (6.1%). Conclusions: Contemporary practice of adrenalectomy shows that robotic adrenalectomy is safe and effective irrespective of the tumor size.

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“…[85] Multiple studies have compared laparoscopic and robotic-assisted adrenalectomy in non-gravid patients, and have found both techniques to be safe and effective for experienced adrenal surgeons. [86,87] Limited data is available regarding robotic-assisted adrenalectomy in pregnant patients, though successful operations have been reported. [88][89][90].…”

Section: Timingmentioning

confidence: 99%

Surgical treatment of adrenal tumors during pregnancy

Bartz-Kurycki

Dream

Wang

2022

Rev Endocr Metab Disord

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While most adrenal tumors are identified incidentally and are non-functional, hormone-secreting tumors can cause morbidity and mortality. Hemodynamic lability and hypertension in pregnancy are associated with worse maternal and fetal outcomes. Achieving a diagnosis of hormone excess due to adrenal tumors can be clinically more difficult in the gravid patient due to normal physiologic alterations in hormones and symptoms related to pregnancy. This review focuses on some nuances of the diagnostic work-up, perioperative care, and surgical management of adrenally-mediated cortisol excess, primary aldosteronism, and pheochromocytoma and paraganglioma in the pregnant patient.

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Perioperative outcomes of robotic and laparoscopic adrenalectomy: a large international multicenter experience

Cited by 24 publications

References 19 publications

Robot-assisted vs laparoscopic lateral transabdominal adrenalectomy: a propensity score matching analysis

Robot-assisted vs laparoscopic lateral transabdominal adrenalectomy: a propensity score matching analysis

Robot assisted laparoscopic adrenalectomy: Should this be the new standard?

Surgical treatment of adrenal tumors during pregnancy

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