Retrospective comparison of three minimally invasive approaches for adrenal tumors: perioperative outcomes of transperitoneal laparoscopic, retroperitoneal laparoscopic and robot-assisted laparoscopic adrenalectomy

Abstract

Background To compare the perioperative outcomes of transperitoneal laparoscopic (TLA), retroperitoneal laparoscopic (RLA), and robot-assisted transperitoneal laparoscopic (RATLA) adrenalectomy for adrenal tumors in our center. Methods Between April 2012 and February 2018, 241 minimally invasive adrenalectomies were performed. Cases were categorized based on the minimally invasive adrenalectomy technique. Demographic characteristics, perioperative information and pathological data were retrospectively collected and analyzed. Results This study included 37 TLA, 117 RLA, and 87 RATLA procedures. Any two groups had comparable age, ASA score, Charlson Comorbidity Index, and preoperative hemoglobin. The tumor size for RLA patients was 2.7 ± 1.1 cm, which was significantly smaller compared to patients who underwent TLA/RATLA (p = 0.000/0.000). Operative time was similar in any two groups, while estimated blood loss was lower for RATLA group (75.6 ± 95.6 ml) compared with the TLA group (131.1 ± 204.5 ml) (p = 0.041). Conversion to an open procedure occurred in only one (2.7%) patient in the TLA group for significant adhesion and hemorrhage. There were no significant differences between groups in terms of transfusion rate and complication rate. Length of stay was shorter for the RATLA group versus the TLA/RLA group (p = 0.000/0.029). In all groups, adrenocortical adenoma and pheochromocytoma were the most frequent histotypes. Conclusions Minimally invasive adrenalectomy is associated with expected excellent outcomes. In our study, the RATLA approach appears to provide the benefits of decreased estimated blood loss and length of stay. Robotic adrenalectomy appears to be a safe and effective alternative to conventional laparoscopic adrenalectomy.

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

“…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.…”

“…Most of the previous reports and meta-analysis exhibited similar results in terms of operative complications between these two approaches [24,[47][48][49][50][51][52][53][54]. Brandao et al [23] exhibited a not significant trend favoring robot-assisted adrenalectomy for postoperative complications in an analysis including 600 adrenalectomies performed mostly by the transperitoneal route (in 72.5% of robot-assisted and in 75.5% of laparoscopic adrenalectomy, respectively).…”

Establishment and validation of a nomogram for predicting the surgical difficulty of lateral retroperitoneal laparoscopic adrenalectomy

“…Nevertheless, with increasing surgical experience and the improvements in laparoscopic instruments, tumor size is no longer an absolute contraindication to LRLA ( 15 ). Despite this, the retroperitoneum is a limited operative space, especially if the adrenal mass is large, making the procedure more challenging ( 16 ). Additionally, the limited retroperitoneal space can cause interference and collision of surgical instruments, increasing the difficulty of exposing and isolating the adrenal lesion ( 15 ).…”

Robot‐assisted adrenalectomy using a hinotori surgical robot system: Report of first series of six cases

“…Since the first description in 1992, 4 LA has been widely accepted due to its excellent clinical outcomes, and is currently regarded as the gold standard approach for the treatment of most adrenal tumors 5 . Recently, RAA was introduced as a potential alternative to LA to overcome some disadvantageous features of laparoscopic procedures, and there have been various studies showing superior findings of RAA to those of LA 6–13 . In fact, although LA remains more common than RAA in the United States, there is a clear trend toward increasing use of the robotic system in adrenalectomy 7 .…”

“…Adrenalectomy for benign and malignant tumors is a complex surgical procedure, particularly in cases with large, malignant, and/or functioning tumors. Since the first report in 1992, 4 laparoscopic adrenalectomy (LA) has been widely accepted and is currently regarded as the gold standard procedure for most adrenal tumors, 5 while with recent progress in robotic surgery, robot‐assisted adrenalectomy (RAA) has been increasingly performed, and reported to achieve favorable perioperative outcomes in several previous studies 6–13 . For example, Agrusa et al conducted meta‐analysis and a systematic literature review focusing on adrenalectomy, and showed that RAA is a feasible surgical option, with reduced blood loss and short length of hospital stay compared with LA 8 …”