Robotic Versus Laparoscopic Resection of Large Adrenal Tumors

Abstract

Our study shows that the use of the robot could shorten operative time and decrease the rate of conversion to open for adrenal tumors larger than 5 cm. Based on our favorable experience, robotic adrenalectomy has become our preferred minimally invasive surgical approach for removing large adrenal tumors.

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

“…In the Karabulut et al study, 28 cases were performed by two groups of staff (OR time = 142 ± 12 min) and 22 cases were done by one group of staff and one fellow (OR time: 201 ± 12 min); the difference in operative time was significantly different (p = 0.002) [18]. Agcaoglu et al also reported the presence of a fellow or a resident in almost 50% of surgeries in both groups, but this fact did not affect the operative time significantly [14].…”

“…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.…”

“…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].…”

“…The patient in the robotic group died after 18 mo of followup presenting multifocal recurrence. The other two patients, from the laparoscopic arm, remained alive after 9 mo and 49 mo, respectively, of follow-up (one with no recurrence, and the second underwent resection and chemotherapy for recurrence after 6 mo) [14]. Aliyev et al reported a median follow-up of 12 mo for pheochromocytoma patients.…”

Robot-assisted adrenalectomy: current perspectives

“…Most of these studies have been retrospective observational comparative studies, 13,14,[16][17][18][19][20][21][22][23][24]26 and only one of them was a randomized controlled trial. 15 One of the first series comparing LA with robotic adrenalectomy was by Morino et al who evaluated outcomes in 10 patients who underwent laparoscopic and robotic adrenalectomy.…”