Robot Assisted Laparoscopic Adrenalectomy: Does Size Matter?

Abstract

Objective: Open adrenalectomy (OA) is considered to be the standard care for large adrenal tumors. Minimally invasive surgery (MIS) using laparoscopic technique is considered for many patients in the modern era. Robot assisted laparoscopic adrenalectomy (RALA) can be an extremely useful tool which will negate the disadvantage of laparoscopic method. The aim of the present study is to determine whether adrenal tumor size and laterality have an impact on patients undergoing RALA with respect to perioperative and postoperative outcomes. Methods: During the study period, 38 patients who underwent RALA in a tertiary care center were considered for retrospectively analysis. The study populations were subdivided into distinctive groups based on the tumor size (<5 cm and ≥5 cm, <8 cm and ≥8 cm), and side (right and left side). For all the subgroups, perioperative and postoperative outcomes were analyzed. Perioperative and postoperative outcomes were assessed between patient groups, group a) <5 cm and ≥5 cm tumor, group b) <8 cm and ≥8 cm, and group c) laterality (right vs left). Results: None of the patients showed any differences. In the current study, the conversion rate, readmission, and mortality were not observed. No major complications were noted. Conclusion: RALA appears to be an extremely viable alternative to MIS using laparoscopic technique. The operative time, console time, blood loss, complication rates, and stay were extremely minimal irrespective of the size or laterality of the adrenal tumor.

Postoperative outcomes of minimally invasive adrenalectomy: do body mass index and tumor size matter? A single-center experience

“…Tumor size also, it’s a clinical finding that could change the approach-decision making. This happens because, usually, in tumors larger than 5 cms, malignancy should be suspected [ 6 ]. In these cases, an open approach could be preferred [ 6 ], and frequently, tumors > 5 cm are related to increased operative time and intraoperative blood loss, according to Morelli et al [ 34 ].…”

“…This happens because, usually, in tumors larger than 5 cms, malignancy should be suspected [ 6 ]. In these cases, an open approach could be preferred [ 6 ], and frequently, tumors > 5 cm are related to increased operative time and intraoperative blood loss, according to Morelli et al [ 34 ]. Our data support these findings because tumor volume shows a linear relationship with blood loss and operative time.…”

“…Since the advancement of robotic technology in surgery, novel approaches have been described for abdominal procedures including metabolic and gastrointestinal surgery, and the field of adrenalectomies isn’t an exception [ 12 ]. In 1999 Piazza et al [ 13 ] reported the first adrenalectomy with robotic technology, since then, multiple authors have published their results such as Ragavan and Vatansever et al [ 6 , 14 ] showing improvement in postoperative outcomes in terms of lesser complications rate, conversion rate, and shorter in-hospital stay compared with conventional laparoscopic approach [ 14 ].…”

“…Since 1992, Gagner et al described the first laparoscopic adrenalectomy (LA) [1,2], advances in technique and multidisciplinary approach allow for treatment in the present time adrenal masses up to 11-12 cm with acceptable morbidity rates that could vary between 0 and 27% in some series of cases [2][3][4][5][6]. Traditionally, LA it's considered the gold standard approach to treating adrenal masses due to the lower rates of morbidity, mortality, decreased in-hospital stay, and lower intraoperative blood loss.…”

Initial Experience of Robot-Assisted Adrenalectomy in Japan: What is the Optimal Selection of Robotic Forceps for Adrenalectomy?

“…[3][4][5][6][7][8][9][10][11] In addition, it has been suggested that RA may have a benefit in large adrenal tumors (>6 cm), obese patients, and patients with previous abdominal surgery compared with LA. [12][13][14] Furthermore, RA for pheochromocytoma achieves better outcomes than LA in terms of safety and efficacy. 11 However, a major issue is the high cost of RA compared to LA and OA, 5,8,15 and the long-term oncological outcomes of RA are still unknown.…”