Robot-assisted adrenalectomy: indications and drawbacks

Abstract

Adrenal tumors can vary from a benign adrenocortical adenoma with no hormonal secretion to a secretory adrenocortical malignancy (adrenocortical carcinoma) or a hormone-secreting tumor of the adrenal medulla (pheochromocytoma). Currently, laparoscopic adrenalectomy is regarded as the preferred surgical approach for the management of most adrenal surgical disorders, although there are no prospective randomized trials comparing this technique with open adrenalectomy. However, widespread adoption of robotic technology has positioned robotic adrenalectomy as an option in some medical centers. Speculative advantages associated with the use of the robotic system have rarely been evaluated in clinical settings and cost increase remains an important drawback associated with robotic surgery. This review summarizes current available data regarding robotic transperitoneal adrenalectomy including its indications, advantages, limitations, and comparison with conventional laparoscopic adrenalectomy. We believe that the use of a robotic system seems to be useful especially in more difficult patients with larger tumors, truncal paragangliomas, and bilateral and/or partial adrenalectomies. Overall, we believe that overcosts due to robotic system use could be balanced by hospital stay decrease, patients' referral increase, improved postoperative outcomes in more difficult patients and ergonomics for the surgeon. However, we also believe that the current surgical intuitive business model is counterproductive, because there are no available strong clinical data that could balance overcosts associated with the use of the robotic system.

Comparison of robot-assisted retroperitoneal laparoscopic adrenalectomy versus retroperitoneal laparoscopic adrenalectomy for large pheochromocytoma: a single-centre retrospective study

“…The postoperative BP improvement rate reflects the effect of surgical resection of PHEO, and the rate in the RARLA group was similar to that in the RLA group during longterm postoperative follow-up. Robotic surgery has some inherent drawbacks, such as a lack of haptic feedback, high purchase and maintenance costs, and large equipment that is difficult to move [23,[25][26][27][28][29]. However, these defects can be offset by more stable intraoperative haemodynamics, less intraoperative bleeding, and a faster postoperative recovery.…”

A case of adrenal cortical carcinoma with inferior vena cava thrombus extending into the right atrium: a two staged procedure

“…1,3 Radiotherapy is used as an adjuvant or as palliation in cases of unresectable tumors. 6 The origin of the tumor and definitive diagnosis are obtained by histopathology and immunohistochemistry. Robotic adrenalectomy is useful in larger tumors, partial or bilateral adrenalectomies, and in truncal paragangliomas.…”

Retrospective analysis of variant venous anatomy in 303 laparoscopic adrenalectomies and its clinical implications

“…However, whether RA could provide a potential advantage in operative time was conflicting . There were various studies suggesting more operative time in either the RA group or LA groups, influenced by learning curve, robot setup, and docking time . As RA is related to superior ergonomics, enhanced visualization of the three‐dimensional laparoscopic view, tremor filtration, “wrist” joints, and as it is considered to be useful especially in more difficult patients with larger tumors and pheochromocytomas, further studies are needed to evaluate the role of the robot‐assisted procedures in patients with variant venous anatomy.…”