Robotic Versus Laparoscopic Adrenalectomy: Pluriannual Experience in a High-Volume Center Evaluating Indications and Results

Abstract

Background: Robotic adrenalectomy offers several clinical benefits if compared with laparoscopic adrenalectomy; however, its superiority is still under debate. The aim of this study was the investigation of differences between the two techniques, and a comparison when approaching right or left side adrenal lesions was further conducted. Materials and Methods: All patients undergoing laparoscopic and robotic unilateral adrenalectomy at our institution from January 2006 to December 2019 were collected and retrospectively analyzed. Statistical analysis was conducted; differences between the two cohorts were reported. Results: A total of 160 cases were included (84 patients in laparoscopic adrenalectomy-group [LA-g] 76 cases in robotic adrenalectomy-group [RA-g]). The groups were homogeneous for demographic data. No intraoperative complications were reported; mean amount of intraoperative blood loss was comparable. No cases of conversion to open surgery were required. RA-g presented a longer operative time than LA-g for right adrenalectomy ( P = .05), no differences were noted for left side ( P = .187). Overall morbidity was 21% for LA-g and 10.5% for RA-g ( P = .087), with an inferior rate of surgical complications for RA-g ( P = .024), and for robotic left adrenalectomy than robotic right procedure ( P = .03). Length of hospital stay was shorter for RA-g ( P = .005). Conclusions: Robotic adrenalectomy presents similar outcomes as laparoscopic approach with some benefits for selected cases. Left adrenal lesions seem to receive greater advantages from robotic technique. Large randomized controlled trials are required to determine the role of robotic adrenal surgery and if the indication can be standardized based on the laterality of adrenal procedure.

Robotic Versus Laparoscopic Adrenalectomy: Systemic Review

“…This finding could be due to a bias in patients' selection because surgeons tend to choose patients who are generally fitter to facilitate robotic procedures. However, 3 of our studies reported higher BMI with the robotic group than the laparoscopic group [21,25,30]. There was a significantly longer operative time in the robotic group than the laparoscopic group.…”

“…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.…”

Robot‐assisted adrenalectomy using a hinotori surgical robot system: Report of first series of six cases

“…Since the first description in 1992, 4 LA has been widely accepted due to its excellent clinical outcomes, and is currently regarded as the gold standard approach for the treatment of most adrenal tumors 5 . Recently, RAA was introduced as a potential alternative to LA to overcome some disadvantageous features of laparoscopic procedures, and there have been various studies showing superior findings of RAA to those of LA 6–13 . In fact, although LA remains more common than RAA in the United States, there is a clear trend toward increasing use of the robotic system in adrenalectomy 7 .…”

“…Adrenalectomy for benign and malignant tumors is a complex surgical procedure, particularly in cases with large, malignant, and/or functioning tumors. Since the first report in 1992, 4 laparoscopic adrenalectomy (LA) has been widely accepted and is currently regarded as the gold standard procedure for most adrenal tumors, 5 while with recent progress in robotic surgery, robot‐assisted adrenalectomy (RAA) has been increasingly performed, and reported to achieve favorable perioperative outcomes in several previous studies 6–13 . For example, Agrusa et al conducted meta‐analysis and a systematic literature review focusing on adrenalectomy, and showed that RAA is a feasible surgical option, with reduced blood loss and short length of hospital stay compared with LA 8 …”

A case of robot‐assisted adrenalectomy performed for an adrenal tumor (anastomosing hemangioma) exceeding 7 cm

“…These reports suggest that RA may be effective for tumors with diameters of 5-6 cm or larger. Piccoli et al 4 compared 84 patients treated with LA and 76 patients treated with RA and reported that the operative time was longer for RA than for LA when tumors were located on the right side; however, there was no difference in the operative time between RA and LA when tumors were located on the left side. Furthermore, they reported that the incidence of postoperative complications was lower in patients undergoing RA.…”