Robotic-Assisted Retroperitoneoscopic Adrenalectomy: Making a Good Procedure Even Better

Abstract

Posterior retroperitoneoscopic adrenalectomy (PRA) is a minimally invasive procedure offering several advantages over a transabdominal laparoscopic operation. The three-dimensional optics and articulating instrumentation offered by current robotic surgical technology potentially improve this procedure. Robotic-assisted PRA (RA-PRA) was performed in patients meeting standard criteria for minimally invasive adrenalectomy. We prospectively collected demographic, clinical, perioperative, and pathologic data on patients undergoing RA-PRA. Thirty consecutive RA-PRAs were performed in 28 patients (26 unilateral and 2 bilateral). Indications for adrenalectomy included pheochromocytoma (8), hyperaldosteronism (3), hypercortisolism (8), oligometastases (5), and nonfunctional tumors (6). Mean tumor size was 3.8 ± 1.6 cm. Mean body mass index was 30.7 ± 6.5 kg/m2. Mean operative time was 154 ± 43 minutes for unilateral total adrenalectomy. Four patients with multiple endocrine neoplasia Type 2A-associated pheochromocytomas underwent cortical-preserving procedures. Three patients experienced perioperative complications (one pneumothorax, one urinary retention, one required postoperative blood transfusion). No patient required conversion to an open procedure. Robotic surgical technology is an excellent complement to retroperitoneoscopic adrenalectomy. The three-dimensional view and ergonomic advantages of a robotic procedure promote better visualization and a more flexible approach to dissection. We believe these features may optimize the ability to maintain a vascularized remnant during minimally invasive cortical-sparing adrenalectomy.

Systematic Review of Surgical Approaches for Adrenal Tumors: Lateral Transperitoneal versus Posterior Retroperitoneal and Laparoscopic versus Robotic Adrenalectomy

“…Robotic surgery with a similar operation time and ergonomic improvements relative to laparoscopic surgery is attractive for surgeons, since robotic procedures offer more delicate dissection using endowrist and a magnified view. Robotic adrenalectomy may have advantages in maintaining a vascularized remnant during cortical sparing adrenalectomy [ 39 ]. However, it is unclear whether the substantial additional cost of the robotic procedure ($3,466 versus $2,737) is justified, since outcomes are equivalent [ 28 ].…”

Robotic Versus Laparoscopic Adrenalectomy: Systemic Review

“…From our systematic literature review we identified 18 studies which were eligible in our study. 10 of them were prospective [12,18,19,20,13,21,22,23,24,25] and 8 were retrospective [26,27,28,29,30,31,32,33]. Seven of these studies were conducted in USA, 5 in Korea, two in Italy, one in Taiwan, one in France, one in China and one was share between Italy and France.…”

Preliminary experience of the robot-assisted laparoscopic excision of a retroperitoneal mass: A case report

“…Currently there are a number of reports concerning robot-assisted laparoscopic resection for adrenal tumors, such as PHEO ( 15 , 16 ). As the occurrence of extra-adrenal paraganglioma is rare, reports regarding this type of tumor are also uncommon, to the best of our knowledge, only Lehrfeld et al ( 14 ) have presented their experience of conducting a robot-assisted excision of a retroperitoneal mass in 2010.…”