Robotic-assisted unilateral adrenalectomy: risk factors for perioperative complications in 303 consecutive patients

Greilsamer, Tristan; Nomine-Criqui, Claire; Thy, Michaël; Ullmann, Timothy M.; Zarnegar, Rasa; Bresler, L.; Brunaud, Laurent

doi:10.1007/s00464-018-6346-2

Cited by 35 publications

(37 citation statements)

References 28 publications

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“…Taking into consideration studies with more than 5 patients, morbidity varied from 0 to 27.2% (see Table 1). In a recent large case series of more than 300 patients [19], it has been reported a post-operative complication rate of 9.2%; reoperations for severe complications (Clavien > 3b) were required in only 1% of cases. These data are substantially superimposable to whom reported by large series of LA [20][21][22].…”

Section: Complications and Conversion Ratementioning

confidence: 98%

“…Moreover, Agcaoglu et al [35] reported that the transport of the robotic unit to the operating room, system start-up, draping of the robotic arms and calibrating the robotic camera can take up to 20-25 min. Additionally, it is reported by several studies that the surgeon's experience has an impact on influencing the OT [19,30,35,38]. Indeed, Greilsamer et al [19] reported a significant decrease of the operating time between the first 100 RA and the last 100 RA.…”

Section: Operative Timementioning

confidence: 99%

“…Additionally, it is reported by several studies that the surgeon's experience has an impact on influencing the OT [19,30,35,38]. Indeed, Greilsamer et al [19] reported a significant decrease of the operating time between the first 100 RA and the last 100 RA. Similarly, Agcaoglu et al [35] reported a significant reduction in the operative time after the 10th RA with retroperitoneal approach, reaching lower values than the laparoscopic counterpart and shortening the skin-to-skin operative time by 28 min.…”

Section: Operative Timementioning

confidence: 99%

“…Moreover, Greilsamer et al [19]reported four independent factors for intra-operative and post-operative complications: history of previous ipsilateral surgical procedure, tumor size, patient's age, and need of conversion. In particular, regarding previous abdominal surgery, this datum is in contrast with those reported by a study conducted by Morris et al [20], which investigates the influence of surgical history on complication rate of LA, without finding any significant association.…”

Section: Complications and Conversion Ratementioning

confidence: 99%

“…Regarding operative times (OT), there is a wide range reported by several studies which varies from 89 to 215 min (see Table 1) [9,19].…”

Section: Operative Timementioning

confidence: 99%

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Robot-assisted adrenalectomy: state of the art

Materazzi

Rossi

2020

Updates Surg

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Currently, laparoscopic adrenalectomy is worldwide considered the gold standard technique. Both transperitoneal and retroperitoneal approaches have proved their efficacy with excellent outcomes. Since the introduction of da Vinci System (Intuitive Surgical, Sunnyvale, CA), robotic surgery has made many steps forward gaining progressively more diffusion in the field of general and endocrine surgery. The robotic technique offers advantages to overcome some laparoscopic shortcomings (rigid instruments, loss of 3D vision, unstable camera). Indeed, the robotic system is provided of stereoscopic 3D-magnified vision, additional degree of freedom, tremor-filtering technology and a stable camera. Recently, several case series have demonstrated the feasibility and the safety of robot-assisted adrenalectomy in high-volume centers with outcomes comparable to laparoscopic adrenalectomy. Notwithstanding, the technical advantages of the robotic system have not yet demonstrated significant improvements in terms of outcomes to undermine laparoscopic adrenalectomy. Moreover, robotic adrenalectomy harbor inherits drawbacks, such as longer operative time and elevated costs, that limit its use. In particular, the high cost associated with the use of the robotic system is primarily related to the purchase and the maintenance of the unit, the high instruments cost and the longer operative time. Notably, these aspects make robotic adrenalectomy up to 2.3 times more costly than laparoscopic adrenalectomy. This literature review summarizes the current available studies and provides an overview about the robotic scenario including applicability, technical details and surgical outcomes.

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