Robotic adrenalectomy: technical aspects, early results and learning curve (original) (raw)
Related papers
Surgery, 2012
Background. Recently, robotic techniques have been described for adrenalectomy. However, scant data exist in the literature regarding the comparison of robotic with the conventional laparoscopic approach. We aimed to analyze intraoperative time use and perioperative outcomes in robotic vs laparoscopic adrenalectomy for both lateral transabdominal (LT) and posterior retroperitoneal (PR) approaches. Methods. A robotic adrenalectomy program was started in September 2008, and techniques for both the LT (n = 32) and PR (n = 18) approaches were established. Data of robotic cases were compared with those of 50 consecutive laparoscopic cases (LT = 32, PR = 18) before the onset of the program from a prospective, institutional review board-approved database. Operative times for individual steps of the procedures were captured from operative video recordings, including docking, exposure, dissection, and hemostasis. Results. For both LT and PR approaches, there was no difference when we compared the robotic with the laparoscopic groups regarding demographics, tumor type, and body mass index. For the LT approach, despite larger tumor size (x ± SEM) in the robotic vs the laparoscopic group (4.7 ± 0.4 vs 3.8 ± 0.4 cm, P = .05), the operative times were similar (168 ± 10 minutes vs 159 ± 8 minutes, P = .5). There was no difference between the two approaches regarding the time spent for the individual steps of the operation. In the PR approach, with similar tumor sizes (2.7 ± 0.3 cm vs 2.3 ± 0.3 cm, P = .4), operative time (minutes) was equivalent (166 ± 9 vs 170 ± 15; P = .8). Time spent intra-operatively for each step was similar, except for shorter hemostasis time in the robotic group (23 ± 4 minutes vs 42 ± 9 minutes, P = .03). The robotic docking time (21 vs 25 minutes) decreased by 50% in the second year of the study for both approaches. The presence of two staff surgeons vs a staff and a fellow decreased operative time for the robotic LT (P <.02) but not the robotic PR approach. For laparoscopic and robotic procedures, the morbidity was 10% and 2%, respectively. Overall, hospital stay was 1.5 ± 0.9 days (range, 1-4 vs 1.1 ± 0.3 days) (range, 1-2; P = .006). The percentage of patients requiring more than 1 day of hospital stay was 28% vs 14% (P = .09). Conclusion. To our knowledge, this is the first study reporting an intraoperative time analysis for robotic adrenalectomy. Intraoperative time use was similar between the laparoscopic and robotic groups for both LT and PR approaches. However, the morbidity was less and hospital stay was shorter after the robotic procedures. (Surgery 2012;151:537-42.)
Robot-assisted adrenalectomy: a technical option for the surgeon?
The International Journal of Medical Robotics and Computer Assisted Surgery, 2010
Background The robotic approach is an interesting option for overcoming the limitations of laparoscopic adrenalectomy. We aimed to report our technique and outcomes of robot-assisted adrenalectomy (RAA). Methods From November 2000 to February 2010, all consecutive patients who underwent a RAA by the same surgeon were prospectively entered into a dedicated database. The data were reviewed retrospectively. Results During the study period, 21 right (50%), 20 left (47.6%) and 1 bilateral (2.4%) RAA were performed. Mean lesion size was 5.5 cm (max. 10 cm). Mean operative time was 118 ± 46 min and median blood loss was 27 ml. There were no conversions. The postoperative morbidity rate was 2.4%; mortality rate, 2.4%; median hospital stay, 4 days. Conclusions RAA achieves good short-term outcomes and could be considered a valid option for the treatment of adrenal masses, with the potential to expand the limits of minimally invasive surgery.
Robotic Adrenalectomy: An Initial Experience in a Turkish Regional Hospital
Frontiers in Surgery
BackgroundDue to the technical advantages and the convenience it provides to surgeons, “robotic adrenalectomy” is a widely used procedure for adrenal surgeries. In this study, we aim to evaluate our robotic adrenalectomy experience and delineate the factors that have a substantial impact on surgical outcomes.MethodsSuccessive 0 transperitoneal robotic operations using the daVinci SI® platform were grouped according to the surgery side, malignant or benign pathologies, for adenoma or non-adenoma lesions, tumor size of less than 4 cm or above, body mass index below or above 30 kg/m2, and with or without laparotomy history. Groups were compared in terms of duration of the operations, amount of bleeding, and the duration of hospitalization.ResultsMorbidity developed in 5 patients (16.6%), and no mortality was observed. We had only one conversion to perform open surgery (3.3%). Operations performed for adenoma significantly last longer when compared with the non-adenoma group (p < 0.0...
The American Journal of Surgery, 2008
Background: This study evaluates the perioperative outcomes of robotic-assisted adrenalectomy (RA) compared with lateral transperitoneal laparoscopic adrenalectomy (LA). Methods: Prospective evaluation of 50 patients who underwent unilateral RA versus 59 patients who underwent unilateral LA. Results: RA was associated with lower blood loss (49 mL) but longer operative times (104 minutes) (P Ͻ.001). However, the difference in operative time was not significant after the learning curve of 20 cases. In patients with body mass index (BMI) Ն30 kg/m 2 , mean operative time was longer in the LA group (90 vs 78 minutes, P ϭ .03) but not in the RA group. In patients with large tumors (Ն55 mm), mean operative time was longer in the LA group (100 vs 80 minutes, P ϭ .009) but not in the RA group. Conversion rate, morbidity, and hospital stay were similar in both groups. Conclusions: After a learning curve of 20 cases, RA has similar perioperative outcomes compared to lateral transperitoneal LA. Several criteria (previous laparoscopic expertise, first assistant's skill and tumor side) remain determinative on RA operative time.
Robotic Versus Laparoscopic Resection of Large Adrenal Tumors
Annals of Surgical Oncology, 2012
Background. Although recent studies have shown the feasibility and safety of robotic adrenalectomy, an advantage over the laparoscopic approach has not been demonstrated. Our hypothesis was that the use of the robot would facilitate minimally invasive resection of large adrenal tumors. Methods. Adrenal tumors C5 cm resected robotically were compared with those removed laparoscopically from a prospective institutional review board-approved adrenal database. Clinical and perioperative parameters were analyzed using t and chi-square tests. All data are expressed as mean ± standard error of mean. Results. There were 24 patients with 25 tumors in the robotic group and 38 patients with 38 tumors in the laparoscopic group. Tumor size was similar in both groups (6.5 ± 0.4 [robotic] vs 6.2 ± 0.3 cm [laparoscopic], P = .661). Operative time was shorter for the robotic versus laparoscopic group (159.4 ± 13.4 vs 187.2 ± 8.3 min, respectively, P = .043), while estimated blood loss was similar (P = .147). The conversion to open rate was less in the robotic (4%) versus the laparoscopic (11%) group; P = .043. Hospital stay was shorter for the robotic group (1.4 ± 0.2 vs 1.9 ± 0.1 days, respectively, P = .009). The 30-day morbidity was 0 in robotic and 2.7% in laparoscopic group. Pathology was similar between groups. Conclusions. 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.
Gland Surgery
Background: With increased utilization of robotic technology, robotic adrenalectomy (RA) became popular in certain high-volume centers as an alternative to conventional laparoscopic adrenalectomy (LA). The aim of the present study was to evaluate clinical and surgical outcomes of RA in two high-volume centers in Turkey. Methods: Between 2012 and 2019, consecutive patients who underwent robotic transperitoneal adrenalectomy in two referral centers for surgical endocrine diseases in Turkey were analyzed retrospectively. Results: A total of 111 patients were analyzed. Mean diameter of the tumor in preoperative imaging was 38.6±2.0 mm. Total operation time was 135.4±47.9 min. The analysis of the learning curve period and the post-learning curve period in both centers demonstrated that the total surgery time decreased from 152.68±48.6 to 118.8±37.1 min, and the console time decreased from 113.2±38.9 to 81.6±35.1 min (P<0.0001). In 8 patients, complications arose during the surgery and postoperative complications were observed in 10 patients. Intraoperative complication rate was 28% in patients with a tumor diameter of greater than 50 mm (P<0.0001). There was no mortality. Conclusions: Our study demonstrated that RA is a safe and effective procedure with low-morbidity and without mortality in high number of cases.
The early results of our initial experience with robotic adrenalectomy
Turkish Journal of Surgery, 2014
Objective: Robotic adrenalectomy is one of the minimally invasive surgical methods gaining wide acceptance due to the three-dimensional imaging system and ergonomics of the equipment. We aimed to present the early data on patients who underwent robotic adrenalectomy due to adrenal masses in our hospital.
Robot-assisted adrenalectomy (total, partial, & metastasectomy)
The Urologic clinics of North America, 2014
Robotic-assisted adrenalectomy is an increasingly used intervention for patients with a variety of surgical adrenal lesions, including adenomas, aldosteronomas, pheochromocytomas, and metastases to the adrenal gland. Compared with traditional laparoscopy, robotic adrenalectomy has comparable perioperative outcomes and is associated with improved hospital length of stay and blood loss, though it does come at a cost premium. Emerging literature also supports a role for robotics in partial adrenalectomy and metastasectomy. Ultimately, well-conducted prospective trials are needed to fully define the role of robotics in the surgical management of adrenal disease.
Robot-assisted vs laparoscopic adrenalectomy: a prospective randomized controlled trial
Surgical Endoscopy, 2004
Background: The aim of this study was to assess the benefits and disadvantages of robot-assisted laparoscopic surgery for disorders of the adrenal gland in terms of feasibility, safety, and length of hospitalization. Methods: Twenty consecutive patients with benign lesions of adrenal gland were randomized into two groups: Patients in the laparoscopic group underwent traditional laparoscopic adrenalectomy (LAP), whereas those in the robotic group underwent robot-assisted adrenalectomy (ROBOT) using the da Vinci robotic system. Results: There was no significant difference between the groups in terms of age, sex, body mass index, and size or locations of lesions. Operative times were significant longer in the ROBOT group (total operative time, 169.2 min [range, 136-215] vs 115.3 min (range, 95-155) p < 0.001. Skin-to-skin time was 107 m (range, 77-154) vs 82.1 min (range, 55-120) (p < 0.001). There were no conversions to open surgery. However, conversion to standard laparoscopic surgery was necessary in four of 10 ROBOT patients (40%; left, one right). Perioperative morbidity was higher in the ROBOT group (20% vs 0%). There was no difference in length of hospital stay. In the following ROBOT group, hospital stay was 5.7 days (range, 4-9) vs 5.4 days (range, 4-8) in the LAP group (p = NS). The total cost of the ROBOT procedure ($3,467) was significantly higher than that for LAP ($2,737) (p < 0.01). Conclusion: Laparoscopic adrenalectomy is superior to robot-assisted adrenalectomy in terms of feasibility, morbidity, and cost.