Robotic versus laparoscopic adrenalectomy in obese patients

Abstract

Our study did not show any difference in perioperative outcomes between RA and LA in obese patients. These results suggest that the difficulties in maintaining exposure and dissection in obese patients nullify the advantages of robotic articulating versus rigid laparoscopic instruments in adrenal surgery.

Robotic Versus Laparoscopic Adrenalectomy: A Systematic Review and Meta-analysis

“…The other significant outcome in favor of robotic surgery was the lower estimated blood loss, with a difference between groups reaching statistical significance (p = 0.001); seven of the nine studies reported less bleeding for robotics [14], [15], [16], [17], [18] and [19]. However, the detected difference of about 25 ml is not clinically relevant.…”

“…Brunaud et al pointed out that the robotic approach offered advantages in obese patients as well and that they did not encounter any technical difficulty in their patients with a mean BMI of 30 kg/m2 (maximum of 44 kg/m2 in their series) [17]. In contrast, Aksoy et al reported no significant difference in perioperative outcomes between robot-assisted surgery and laparoscopy in obese patients undergoing adrenalectomy [16]. These authors experienced difficulty using the same robotic trocar configurations in obese patients due to the need for retraction of the spleen and liver compared with normal-weight individuals.…”

“…Five of them compared consecutive series of patients (level of evidence [LE]: 3a) [14], [15], [16], [17] and [18], and two performed a retrospective nonconsecutive study (LE: 3b) [19] and [20]. Only one of the studies was an RCT (LE: 2b) [21].…”

“…There were more severe complications in the laparoscopic group, according to the Clavien grading system, including three deaths (Clavien grade 5), two resulting from respiratory failure due to severe pulmonary hypertension [16] and [18] and one from cardiac arrest [25]. You et al reported two grade 4 complications in the laparoscopic group (acute kidney failure and cerebral infarction) requiring intensive care unit treatment [20].…”

“…You et al reported two grade 4 complications in the laparoscopic group (acute kidney failure and cerebral infarction) requiring intensive care unit treatment [20]. In the robot-assisted group, there was one grade 3 complication in two studies [16] and [17]. In his RCT study, Morino et al demonstrated that robot-assisted surgery is comparable with conventional laparoscopy in terms of postoperative morbidity and mortality [21].…”