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Li YG, Chen XB, Wang CM, Yu XD, Deng XZ, Liao B. Robotic posterior retroperitoneal adrenalectomy versus laparoscopic posterior retroperitoneal adrenalectomy: outcomes from a pooled analysis. Front Endocrinol (Lausanne) 2023; 14:1278007. [PMID: 38089626 PMCID: PMC10715275 DOI: 10.3389/fendo.2023.1278007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
Background The comparative advantages of robotic posterior retroperitoneal adrenalectomy (RPRA) over laparoscopic posterior retroperitoneal adrenalectomy (LPRA) remain a topic of ongoing debate within the medical community. This systematic literature review and meta-analysis aim to assess the safety and efficacy of RPRA compared to LPRA, with the ultimate goal of determining which procedure yields superior clinical outcomes. Methods A systematic search was conducted on databases including PubMed, Embase, Web of Science, and the Cochrane Library database to identify relevant studies, encompassing both randomized controlled trials (RCTs) and non-RCTs, that compare the outcomes of RPRA and LPRA. The primary focus of this study was to evaluate perioperative surgical outcomes and complications. Review Manager 5.4 was used for this analysis. The study was registered with PROSPERO (ID: CRD42023453816). Results A total of seven non-RCTs were identified and included in this study, encompassing a cohort of 675 patients. The findings indicate that RPRA exhibited superior performance compared to LPRA in terms of hospital stay (weighted mean difference [WMD] -0.78 days, 95% confidence interval [CI] -1.46 to -0.10; p = 0.02). However, there were no statistically significant differences observed between the two techniques in terms of operative time, blood loss, transfusion rates, conversion rates, major complications, and overall complications. Conclusion RPRA is associated with a significantly shorter hospital stay compared to LPRA, while demonstrating comparable operative time, blood loss, conversion rate, and complication rate. However, it is important to note that further research of a more comprehensive and rigorous nature is necessary to validate these findings. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=453816, identifier CRD42023453816.
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Affiliation(s)
- Yu-gen Li
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nan chong, China
| | - Xiao-bin Chen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nan chong, China
| | - Chun-mei Wang
- Physical Examination Center, Affiliated Hospital of North Sichuan Medical College, Nan chong, China
| | - Xiao-dong Yu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nan chong, China
| | - Xian-zhong Deng
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nan chong, China
| | - Bo Liao
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nan chong, China
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Procopio PF, Pennestrì F, De Crea C, Voloudakis N, Bellantone R, Raffaelli M. Outcome of Partial Adrenalectomy in MEN2 Syndrome: Personal Experience and Systematic Review of Literature. Life (Basel) 2023; 13:life13020425. [PMID: 36836782 PMCID: PMC9965729 DOI: 10.3390/life13020425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/20/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
Background: Partial adrenalectomy (PA) is an alternative option to total adrenalectomy for the treatment of hereditary pheochromocytoma (PHEO) to preserve cortical function and avoid life-long steroid replacement. The aim of this review is to summarize current evidence in terms of clinical outcome, recurrence, and corticosteroid therapy implementation after PA for MEN2-PHEOs. Material and Methods: From a total of 931 adrenalectomies (1997-2022), 16 of the 194 patients who underwent surgical treatment of PHEO had MEN2 syndrome. There were six patients scheduled for PA. MEDLINE®, EMBASE®, Web of Science, and Cochrane Library were searched for English studies from 1981 to 2022. Results: Among six patients who underwent PA for MEN2-related PHEO in our center, we reported two with bilateral synchronous disease and three with metachronous PHEOs. One recurrence was registered. Less than 20 mg/day Hydrocortison therapy was necessary in 50% of patients after bilateral procedures. Systematic review identified 83 PA for MEN2-PHEO. Bilateral synchronous PHEO, metachronous PHEO and disease recurrence were reported in 42%, 26%, and 4% of patients, respectively. Postoperative steroid implementation was necessary in 65% of patients who underwent bilateral procedures. Conclusions: PA seems to be a safe and valuable option for the treatment of MEN2-related PHEOs, balancing the risk of disease recurrence with the need for corticosteroid therapy.
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Affiliation(s)
- Priscilla Francesca Procopio
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Francesco Pennestrì
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
- Correspondence:
| | - Carmela De Crea
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- U.O.C. Chirurgia Endocrina, Fatebenefratelli Isola Tiberina-Gemelli Isola, 00186 Roma, Italy
| | - Nikolaos Voloudakis
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Rocco Bellantone
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Marco Raffaelli
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
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3
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Robotic approach for partial adrenalectomy. Updates Surg 2021; 73:1147-1154. [PMID: 33411221 DOI: 10.1007/s13304-020-00957-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
Although safe and feasible, partial adrenalectomy is not a widespread procedure. Endorsement of robotic technologies and fluorescence techniques in adrenal surgery might help develop partial adrenalectomy and could avoid unnecessary total adrenalectomies. When performed in selected cases, partial adrenalectomy is associated with good postoperative outcomes comparable with those reported after total adrenalectomy. It has been hypothesized that one of the advantages of the robotic approach in adrenal-sparing surgery is to reduce manipulation of the gland allowing preservation of the vascularization of the residual adrenal, overcoming some limits when performing a laparoscopic conventional approach. A major drawback of the robotic surgery is its cost, but the overcost due to the use of the robotic system could be balanced by the execution of a high number of partial adrenalectomies leading to fewer life-long replacement steroid treatment. Partial adrenalectomy could become the recommended management for small benign and hormonal active adrenal tumors. Indocyanine green fluorescence (IGF) also seems to be a useful technique to help surgeons identify the adrenal gland and to locate small tumors from the normal adrenal tissue in difficult patients. It is likely that the use of a robotic approach associated with IGF may extend indications of partial adrenalectomy in the years to come.
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Seetharam Bhat KR, Moschovas MC, Onol FF, Rogers T, Roof S, Patel VR, Schatloff O. Robotic renal and adrenal oncologic surgery: A contemporary review. Asian J Urol 2021; 8:89-99. [PMID: 33569275 PMCID: PMC7859360 DOI: 10.1016/j.ajur.2020.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/30/2020] [Accepted: 04/22/2020] [Indexed: 01/20/2023] Open
Abstract
Robot-assisted surgery has evolved over time. Radical nephrectomy with inferior vena cava thrombectomy is feasible and safe for level I, II and III thrombus in high volume centers. Though it is feasible for level IV thrombus, this procedure needs a multi-departmental co-operation. However, the safety of robot-assisted procedures in this subset is still unknown. Robot-assisted partial nephrectomy has been universally approved and found oncologically safe. Robotic adrenalectomy has been increasingly utilized for select cases, especially in bilateral tumors and for retroperitoneal adrenalectomy.
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Affiliation(s)
| | | | - Fikret Fatih Onol
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Travis Rogers
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Shannon Roof
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Vipul R. Patel
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Oscar Schatloff
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
- Sudmedica Health, Chile
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Abstract
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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Fu SQ, Zhuang CS, Yang XR, Xie WJ, Gong BB, Liu YF, Liu J, Sun T, Ma M. Comparison of robot-assisted retroperitoneal laparoscopic adrenalectomy versus retroperitoneal laparoscopic adrenalectomy for large pheochromocytoma: a single-centre retrospective study. BMC Surg 2020; 20:227. [PMID: 33028297 PMCID: PMC7539373 DOI: 10.1186/s12893-020-00895-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the feasibility and safety of robot-assisted retroperitoneal laparoscopic adrenalectomy (RARLA) for large pheochromocytomas (PHEOs; size≥6 cm) compared with retroperitoneal laparoscopic adrenalectomy (RLA). METHODS Fifty-one patients who underwent adrenalectomy for large PHEOs between March 2016 and January 2019 were enrolled and divided into two groups, including 32 RLA cases and 19 RARLA cases. We compared the perioperative efficacy and long-term follow-up results between the two groups. RESULTS Preoperative data, including demographics, comorbidities and tumour characteristics, were similar between the groups. Intraoperatively, the RARLA group had a lower incidence of haemodynamic instability (26.3% vs. 56.2%, P = 0.038) and less intraoperative blood loss (100 ml vs. Two hundred milliliter, P = 0.042) than the RLA group. The groups showed no significant differences in operative time or transfusion rates. Postoperatively, the time to diet resumption, time to ambulation, time to drainage removal and postoperative hospital stay were shorter in the RARLA group than in the RLA group (1 d vs. 2 d, P = 0.027; 1 d vs. 2 d, P = 0.034; 3 d vs. 5 d, P = 0.002; 5 d vs. 6 d, P = 0.02, respectively). The groups exhibited no significant differences in the duration of anaesthetic use, complications, or long-term follow-up results for the blood pressure (BP) improvement rate. CONCLUSIONS Compared with RLA, RARLA is a safe, feasible and even optimized procedure for large PHEOs.
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Affiliation(s)
- Sheng-Qiang Fu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China
| | - Chang-Shui Zhuang
- Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, 518052, China
| | - Xiao-Rong Yang
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China
| | - Wen-Jie Xie
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China
| | - Bin-Bin Gong
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China
| | - Yi-Fu Liu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China
| | - Ji Liu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China
| | - Ting Sun
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China
| | - Ming Ma
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China.
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Agcaoglu O, Karahan SN, Tufekci T, Tezelman S. Single-incision robotic adrenalectomy (SIRA): the future of adrenal surgery? Gland Surg 2020; 9:853-858. [PMID: 32775280 DOI: 10.21037/gs-2019-ra-02] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In compliance with the trend toward less invasive techniques, single incision robotic surgeries have become more common and they have been increasingly used for several surgeries including adrenalectomy. Single incision robotic adrenalectomy (SIRA) aims to combine the merits of robotic surgery with previously defined single incision laparoscopic techniques. It has been shown to be safe and feasible, however, there are only few studies on this new technique. Due to scant data on SIRA in the current literature, it remains to be a current challenge in adrenal surgery. In this review, our goal is to present current literature on SIRA and discuss the data regarding perioperative outcomes, patient selection, learning curve, and its limitations.
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Affiliation(s)
- Orhan Agcaoglu
- Department of General Surgery, School of Medicine, Koc University, Istanbul, Turkey
| | - Salih Nafiz Karahan
- Department of General Surgery, School of Medicine, Koc University, Istanbul, Turkey
| | - Tutku Tufekci
- Department of General Surgery, School of Medicine, Koc University, Istanbul, Turkey
| | - Serdar Tezelman
- Department of General Surgery, School of Medicine, Koc University, Istanbul, Turkey
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8
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Gomella PT, Sanford TH, Pinto PA, Bratslavsky G, Metwalli AR, Linehan WM, Ball MW. Long-term Functional and Oncologic Outcomes of Partial Adrenalectomy for Pheochromocytoma. Urology 2020; 140:85-90. [PMID: 32109495 PMCID: PMC7255958 DOI: 10.1016/j.urology.2020.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/10/2020] [Accepted: 02/17/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the recurrence and functional outcomes in a primarily hereditary cohort of patients undergoing partial adrenalectomy for pheochromocytoma. METHODS A retrospective review from a prospectively managed database of patients undergoing partial adrenalectomy from 1995 to 2018 at the National Cancer Institute was performed. Local recurrence was defined as imaging evidence of a recurrent or de novo lesion on the operative side. Steroid dependency was defined as requiring daily steroid replacement at time of last follow-up. RESULTS One hundred and twenty-four partial adrenalectomies, removing 162 tumors, were performed in 107 patients. Most patients had a known hereditary predisposition to develop bilateral, multifocal, and recurrent pheochromocytoma. Median tumor size was 2 cm (interquartile range (IQR) 1.5-2.8). Median follow-up was 60 months (IQR 13-131). Local recurrence occurred in 17 patients (15.8%) and were managed with active surveillance or surgery. A single patient (1/106, 0.9%) developed metastatic spread of pheochromocytoma approximately 14 years after his first of 2 partial adrenalectomies and remains alive under active surveillance. Median time to recurrence was 71 months (IQR 26-127) with 10 patients (9.3%) requiring daily steroid replacement at time of last follow-up. CONCLUSION Partial adrenalectomy offers excellent oncologic and functional outcomes, sparing most patients from lifelong steroid replacement therapy. Recurrences can be easily managed with repeat surgery or active surveillance via functional work-up and imaging. Partial adrenalectomy remains the recommended surgical management for patients pre-disposed to development of bilateral, multifocal and recurrent pheochromocytoma.
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Affiliation(s)
| | - Thomas H Sanford
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD; Department of Urology, SUNY Upstate Medical University, Syracuse, NY
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD
| | - Gennady Bratslavsky
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD; Department of Urology, SUNY Upstate Medical University, Syracuse, NY
| | - Adam R Metwalli
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD; Division of Urology, Howard University, Washington, DC
| | | | - Mark W Ball
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD.
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10
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Agcaoglu O, Makay O. Robotic Adrenalectomy. CURRENT SURGERY REPORTS 2019. [DOI: 10.1007/s40137-019-0240-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Robotic enucleation of adrenal masses: technique and outcomes. World J Urol 2019; 38:853-858. [PMID: 31292732 DOI: 10.1007/s00345-019-02868-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/03/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility and safety of the application of robotic enucleation of adrenal masses (REAM). METHODS Thirteen patients at Shanghai Changhai Hospital who underwent robotic enucleation of adrenal mass from February 2017 to March 2018 were reviewed. After mobilizing the adrenal gland and clamping the feeding blood vessels, the tumor was enucleated and reconstruction was performed. Relevant clinical data were recorded including baseline patient and tumor characteristics, and perioperative outcomes (operating time, ischemic time, estimated blood loss, complications, and so on). RESULTS All cases were successfully completed without conversion to total adrenalectomy or open surgery. The mean operative time was 75 min (range 60-95), with a mean warm ischemia time of 12 min (range 8-17). The estimated blood loss was 20 mL (range 10-50). No intraoperative complications were observed, and no steroid replacement was given post-operatively. After a median follow-up period of 12 months (range 9-15), no evidence of disease recurrence was detected. CONCLUSIONS Robotic enucleation of adrenal masses is a safe and feasible procedure with excellent short-term functional and oncologic outcomes. Steroid supplementation is not necessary and recurrence is not usual with limited follow-up. Long-term follow-up and larger studies should be conducted to further evaluate outcomes of this robotic adrenal-sparing approach.
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Ruhle BC, Ferguson Bryan A, Grogan RH. Robot-Assisted Endocrine Surgery: Indications and Drawbacks. J Laparoendosc Adv Surg Tech A 2019; 29:129-135. [DOI: 10.1089/lap.2018.0308] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Brian C. Ruhle
- Section of Endocrine Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Ava Ferguson Bryan
- Section of Endocrine Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Raymon H. Grogan
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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Simone G, Anceschi U, Tuderti G, Misuraca L, Celia A, De Concilio B, Costantini M, Stigliano A, Minisola F, Ferriero M, Guaglianone S, Gallucci M. Robot-assisted Partial Adrenalectomy for the Treatment of Conn's Syndrome: Surgical Technique, and Perioperative and Functional Outcomes. Eur Urol 2018; 75:811-816. [PMID: 30077398 DOI: 10.1016/j.eururo.2018.07.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/19/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND In the era of minimally invasive surgery, partial adrenalectomy has certainly been underused. We aimed to report surgical technique and perioperative, pathologic, and early functional outcomes of a two-center robot-assisted partial adrenalectomy (RAPA) series. OBJECTIVE To detail surgical technique of RAPA for unilateral aldosterone-producing adenoma (UAPA), and to report perioperative and 1-yr functional outcomes. DESIGN, SETTING, AND PARTICIPANTS Data of 10 consecutive patients who underwent RAPA for UAPA at two centers from June 2014 to April 2017 were prospectively collected and reported. SURGICAL PROCEDURE RAPA was performed using a standardized technique with the da Vinci Si in a three-arm configuration. MEASUREMENTS Baseline and perioperative data were reported. One-year functional outcomes were assessed according to primary aldosteronism surgery outcome guidelines. A descriptive statistical analysis was performed. RESULTS AND LIMITATIONS All cases were completed robotically. Median nodule size was 18mm (interquartile range [IQR] 16-20). Intraoperative blood loss was negligible. A single (10%) postoperative Clavien grade 2 complication occurred. Median hospital stay was 3 d (IQR 2-3). Patients became normotensive immediately after surgery (median pre- and postoperative blood pressure: 150/90 and 120/70mmHg, respectively). At both 3-mo and 1-yr functional evaluation, all patients achieved biochemical success (aldosterone level, plasmatic renin activity, and aldosterone-renin ratio within normal range). Complete clinical success was achieved in nine patients, but one required low-dose amlodipine at 6-mo evaluation. At a median follow-up of 30.5 mo (IQR 19-42), neither symptoms nor imaging recurrence was observed. CONCLUSIONS We demonstrated feasibility and safety of RAPA for UAPA; this technique had very low risk of complications and excellent functional results. Increased availability of robotic platform and increasing robotic skills among urologists make RAPA a treatment option with potential for widespread use in urologic community. PATIENT SUMMARY Robot-assisted partial adrenalectomy is a safe, feasible, and minimally invasive surgical approach. Promising perioperative and functional outcomes suggest an increasing adoption of this technique in the near future.
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Affiliation(s)
- Giuseppe Simone
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy.
| | - Umberto Anceschi
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano Del Grappa, Italy
| | | | - Manuela Costantini
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Antonio Stigliano
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Rome, Italy
| | - Francesco Minisola
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | | | | | - Michele Gallucci
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
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Nomine-Criqui C, Germain A, Ayav A, Bresler L, Brunaud L. Robot-assisted adrenalectomy: indications and drawbacks. Updates Surg 2017; 69:127-133. [DOI: 10.1007/s13304-017-0448-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 04/09/2017] [Indexed: 12/27/2022]
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Abstract
Laparoscopy has established itself as the procedure of choice for performing adrenalectomy in benign adrenal disorders. Although laparoscopy scores heavily over open approach in terms of lesser blood loss, pain, shorter hospital stay and better cosmesis, it is riddled with certain shortcomings such as the need of dexterity, two-dimensional vision, dependence on an assistant for camera, etc. Robotic surgery promises to overcome these limitations. Multiple series have established that robotic adrenalectomy is a safe and effective procedure as conventional laparoscopy. Recently, robotic surgery has been found to be precise and accurate in performing partial adrenalectomy in hereditary adrenal syndrome cases. Other advances like single-port surgery have expanded the horizon and indications of robotic surgery. This review aims at studying the current evidence available for the effectiveness of robot-assisted adrenalectomy and defining its current status in managing adrenal disorders.
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Affiliation(s)
- Mrinal Pahwa
- Department of Urology and Renal Transplant, GRIPMER, Sir Ganga Ram Hospital, New Delhi, India,
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16
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Laparoscopic versus robotic adrenalectomy: A comprehensive meta-analysis. Int J Surg 2016; 38:95-104. [PMID: 28043926 DOI: 10.1016/j.ijsu.2016.12.118] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 12/10/2016] [Accepted: 12/26/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The benefit of robotic adrenalectomy (RA) compared to laparoscopic adrenalectomy (LA) is still debatable. The purpose of this paper was to systematically review and synthesize all available evidence comparing RA to LA so as to evaluate which procedure provides superior clinical outcomes. METHODS A systematic literature search of PubMed and Scopus databases was performed with respect to the PRISMA statement (end-of-search date: January 31, 2016). Data on perioperative variables were extracted by three independent reviewers. Data were pooled using a random-effects model. RESULTS Twenty-seven studies were included in this review (13 comparative and 14 non-comparative). Overall, 1162 patients underwent adrenalectomy (747 treated with RA and 415 with LA). There was no significant difference between the robotic and the laparoscopic groups for intraoperative complications (OR: 1.20; 95%CI, 0.33-4.38), postoperative complications (OR: 0.69; 95% CI, 0.36-1.31), mortality (OR: 0.42; 95%CI, 0.07-2.72), conversion to laparotomy (OR: 0.51; 95%CI, 0.21-1.23), conversion to laparotomy or laparoscopy (OR: 0.73; 95%CI, 0.32-1.69) and blood loss (WMD: -9.78; 95%, -22.10 to 2.53). For patients treated with RA, there was a significantly shorter hospital stay (WMD: -0.40; 95% CI, -0.64 to -0.17) and a significantly longer operating time (WMD: 15.60; 95%CI, 2.12 to 29.08). CONCLUSIONS Robotic adrenalectomy is a safe and feasible procedure with similar clinical outcomes as the laparoscopic approach in selected patient populations. High quality RCTs as well as uniform and detailed reporting of outcomes are needed to determine the role and cost-effectiveness of robotic adrenal surgery in the years to come.
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Teo XL, Lim SK. Robotic assisted adrenalectomy: Is it ready for prime time? Investig Clin Urol 2016; 57:S130-S146. [PMID: 27995217 PMCID: PMC5161013 DOI: 10.4111/icu.2016.57.s2.s130] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/05/2016] [Indexed: 01/23/2023] Open
Abstract
Adrenal surgery is undergoing continuous evolution and minimally invasive surgery is increasingly being used for the surgical management of adrenal masses. With robotic-assisted surgery being a widely accepted surgical treatment for many urological conditions such as prostate carcinoma and renal cell carcinoma, the use of the robot has been expanded to include robotic-assisted adrenalectomy, offering an alternative minimally invasive platform for adrenal surgery. We performed a literature review on robotic-assisted adrenalectomy, reviewing the current surgical techniques and perioperative outcomes.
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Affiliation(s)
- Xin Ling Teo
- Department of Urology, Changi General Hospital, Singapore
| | - Sey Kiat Lim
- Department of Urology, Changi General Hospital, Singapore
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Waingankar N, Bratslavsky G, Jimenez C, Russo P, Kutikov A. Pheochromocytoma in Urologic Practice. Eur Urol Focus 2016; 1:231-240. [PMID: 28078330 DOI: 10.1016/j.euf.2015.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
CONTEXT Pheochromocytoma is regularly encountered in urological practice and requires a thoughtful and careful clinical approach. OBJECTIVE To review clinical aspects of management of pheochromocytoma in urologic practice. EVIDENCE ACQUISITION A systematic review of English-language literature was performed through year 2015 using the Medline database. Manuscripts were selected with consensus of the coauthors and evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. EVIDENCE SYNTHESIS Findings and recommendations of the evaluated manuscripts are discussed with an emphasis on the description of presentation, diagnosis, evaluation, and perioperative care. CONCLUSION In addition to surgical expertise, appropriate management of pheochromocytoma in urologic practice requires nuanced understanding of pathophysiology, genetics, and endocrinological principles. When skillfully managed, the vast majority of patients with pheochromocytoma should expect an excellent prognosis. PATIENT SUMMARY In this article we review the clinical approach to patients with pheochromocytoma, a tumor that stems from the innermost part of the adrenal gland and that often secretes excessive amounts of powerful hormones such as noradrenaline and adrenaline. Significant expertise is required to appropriately manage patients with these tumors. TAKE HOME MESSAGE In addition to surgical expertise, appropriate management of pheochromocytoma in urologic practice requires nuanced understanding of pathophysiology, genetics, and endocrinological principles. When skillfully managed, vast majority of patients with pheochromocytoma should expect an excellent prognosis.
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Affiliation(s)
| | | | - Camilo Jimenez
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paul Russo
- Memorial Sloan Kettering Cancer Center, New York, New York
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Revisiting robotic approaches to endocrine neoplasia: do the data support their continued use? Curr Opin Oncol 2016; 28:26-36. [PMID: 26632768 DOI: 10.1097/cco.0000000000000245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Although the advent of the robot has revolutionized the modern treatment of endocrine neoplasia, substantial controversies exist on its applicability, safety and benefits over the conventional laparoscopic operations. The present review aims to review the recent literature on various robotic approaches in treating thyroid, parathyroid, adrenal and pancreatic endocrine neoplasia and see whether its continued use should be supported. RECENT FINDINGS In summary, the role of robotic thyroidectomy has been clearly established and should be continued by experienced surgeons on selected patients. Because of the limited availability of evidence, the feasibility of robotic parathyroidectomy has yet to be elucidated. With proven favorable perioperative outcomes, robotic adrenalectomy and pancreatectomy should be continued as potential alternatives to conventional surgery. SUMMARY Robotic endocrine procedures still play a pivotal role in minimally invasive endocrine surgery with demonstrable safety and effectiveness. Future research should embark on prospective randomized-controlled trials on robotic endocrine procedures to collect higher level of evidence and long-term survival data.
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Head docking for single stage robotic cortical sparing adrenalectomy for bilateral pheochromocytoma. J Robot Surg 2015; 9:79-83. [PMID: 26530976 DOI: 10.1007/s11701-014-0487-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
Abstract
The optimal operative approach in a patient with bilateral pheochromocytoma is controversial. Subtotal minimal invasive cortical sparing adrenalectomy is gaining interest in many centers. We describe a novel technique for single stage approach for cortical sparing adrenalectomy for bilateral pheochromocytoma using head docking in order to offer good exposure of bilateral upper peritoneum without requiring patient or robot repositioning.
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Nomine-Criqui C, Brunaud L, Germain A, Klein M, Cuny T, Ayav A, Bresler L. Robotic lateral transabdominal adrenalectomy. J Surg Oncol 2015; 112:305-9. [DOI: 10.1002/jso.23960] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 06/05/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Claire Nomine-Criqui
- Department of Digestive; Université de Lorraine; CHU Nancy (Hopital Brabois Adultes); Hepato-Biliary; Endocrine Surgery, and Surgical Oncology; France
| | - Laurent Brunaud
- Department of Digestive; Université de Lorraine; CHU Nancy (Hopital Brabois Adultes); Hepato-Biliary; Endocrine Surgery, and Surgical Oncology; France
- INSERM U954; Lorraine University; France
| | - Adeline Germain
- Department of Digestive; Université de Lorraine; CHU Nancy (Hopital Brabois Adultes); Hepato-Biliary; Endocrine Surgery, and Surgical Oncology; France
| | - Marc Klein
- Department of Endocrinology; Université de Lorraine; CHU Nancy (Hopital Brabois Adultes); France
| | - Thomas Cuny
- Department of Endocrinology; Université de Lorraine; CHU Nancy (Hopital Brabois Adultes); France
| | - Ahmet Ayav
- Department of Digestive; Université de Lorraine; CHU Nancy (Hopital Brabois Adultes); Hepato-Biliary; Endocrine Surgery, and Surgical Oncology; France
| | - Laurent Bresler
- Department of Digestive; Université de Lorraine; CHU Nancy (Hopital Brabois Adultes); Hepato-Biliary; Endocrine Surgery, and Surgical Oncology; France
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Nagaraja V, Eslick GD, Edirimanne S. Recurrence and functional outcomes of partial adrenalectomy: A systematic review and meta-analysis. Int J Surg 2015; 16:7-13. [DOI: 10.1016/j.ijsu.2015.01.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 12/27/2014] [Accepted: 01/19/2015] [Indexed: 12/15/2022]
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Ball MW, Allaf ME. Robot-Assisted Adrenalectomy (Total, Partial, & Metastasectomy). Urol Clin North Am 2014; 41:539-47. [DOI: 10.1016/j.ucl.2014.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ho CH, Liao PW, Lin VC, Jaw FS, Chueh SCJ, Chung SD, Liu SP, Tsai YC, Yu HJ. Laparoendoscopic single-site (LESS) retroperitoneal partial adrenalectomy using a custom-made single-access platform and standard laparoscopic instruments: technical considerations and surgical outcomes. Asian J Surg 2014; 38:6-12. [PMID: 24661450 DOI: 10.1016/j.asjsur.2014.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/29/2013] [Accepted: 01/14/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND We previously reported our initial experience with laparoendoscopic single-site (LESS) retroperitoneal partial adrenalectomy using a custom-made single-port device and conventional straight laparoscopic instruments. METHODS Between December 2010 and February 2012, LESS retroperitoneal partial adrenalectomies were performed in 11 patients. Six patients had aldosterone-producing adenomas (APAs) and five patients had nonfunctioning tumors. A single-port access was created with an Alexis wound retractor (Applied Medical, Rancho Santa Margarita, CA, USA) through an incision of 2-3 cm beneath the tip of the 12th rib. All procedures were performed with straight laparoscopic instruments. RESULTS All LESS procedures were successfully completed without conversion to traditional laparoscopic conversion. The tumors ranged from 1 cm to 4.7 cm (mean, 2.3 cm). The operative time was 71-257 minutes (mean, 121 minutes). Most patients (n = 8) had minimal blood loss; the other three patients had a blood loss of 150 mL, 100 mL, and 100 mL. The mean hospital stay was 3 days (range, 1-6 days). There were no perioperative or postoperative complications. Pathological examinations revealed negative surgical margins in all specimens. All patients with Conn's syndrome had an improvement in blood pressure and normalization of plasma renin activity and serum aldosterone levels; all patients were free of potassium supplementation. CONCLUSION Our results clearly demonstrate that LESS retroperitoneal partial adrenalectomy can be performed safely and effectively using a custom-made single-access platform and standard laparoscopic instruments.
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Affiliation(s)
- Chen-Hsun Ho
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Pin-Wen Liao
- Department of Neurology, Cathay General Hospital, Taipei, Taiwan; Department of Medicine, School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Victor C Lin
- Department of Urology, E-Da Hospital, Kaohsiung, Taiwan; Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan
| | - Fu-Shan Jaw
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Shih-Chieh Jeff Chueh
- Glickman Urological and Kidney Institute and Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Shiu-Dong Chung
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, Ban Ciao, Taipei, Taiwan
| | - Shih-Ping Liu
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Chou Tsai
- Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan; Department of Urology, College of Medicine, Tzu Chi University, Hualien, Taiwan.
| | - Hong-Jeng Yu
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
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Shuch B, Ricketts CJ, Metwalli AR, Pacak K, Linehan WM. The genetic basis of pheochromocytoma and paraganglioma: implications for management. Urology 2014; 83:1225-32. [PMID: 24642075 DOI: 10.1016/j.urology.2014.01.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/05/2013] [Accepted: 01/02/2014] [Indexed: 02/09/2023]
Abstract
Chromaffin cells are catecholamine-producing cells derived from neural crest tissue. Chromaffin tumors are rare tumors arising from these cells and are divided into pheochromocytoma arising from adrenal tissue and paraganglioma arising from extra-adrenal ganglia. Previously, ∼10% were believed to be hereditary, but advances in genome sequencing have shown that roughly 35% of apparently sporadic tumors have a hereditary component. In this review, we describe both classic and newly discovered hereditary chromaffin tumors syndromes and provide recommendations for genetic testing. In many cases, the genes associated with these conditions are linked to common kidney cancer pathways familiar to urologic oncologists.
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Affiliation(s)
- Brian Shuch
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Christopher J Ricketts
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Adam R Metwalli
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Karel Pacak
- Developmental Endocrinology Branch, Eunice Kennedy Shriver National Institute of Child Health and Development, National Institutes of Health, Bethesda, MD
| | - W Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
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Gupta GN, Benson JS, Ross MJ, Sundaram VS, Lin KY, Pinto PA, Linehan WM, Bratslavsky G. Perioperative, functional, and oncologic outcomes of partial adrenalectomy for multiple ipsilateral pheochromocytomas. J Endourol 2013; 28:112-6. [PMID: 23998199 DOI: 10.1089/end.2013.0298] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Managing patients with multiple adrenal masses is technically challenging. We present our experience with minimally invasive partial adrenalectomy (PA) performed for synchronous multiple ipsilateral pheochromocytomas in a single setting. MATERIALS AND METHODS We reviewed records of patients undergoing PA for pheochromocytoma at the National Cancer Institute between 1994 and 2010. Patients were included if multiple tumors were excised from the ipsilateral adrenal gland in the same operative setting. Perioperative, functional, and oncologic outcomes of PA for multiple pheochromocytomas are shown. RESULTS Of 121 partial adrenalectomies performed, 10 procedures performed in eight patients for synchronous multiple ipsilateral pheochromocytomas were identified. All eight patients were symptomatic at presentation. The mean patient age was 30.6 years, median follow up was 12 months. The average surgical time was 228 minutes, average blood loss of 125 mL, and average number of tumors removed was 2.6 per adrenal. In total, 26 tumors were removed, 24 were pathologically confirmed pheochromocytomas, while two were adrenal cortical hyperplasia. After surgery, all patients had resolution of their symptoms, one patient required steroid replacement postoperatively. On postoperative imaging, one patient had evidence of ipsilateral adrenal nodule at the prior resection site 2 months postoperatively, which was consistent with incomplete resection. CONCLUSIONS Minimally invasive surgical resection of synchronous multiple pheochromocytomas is feasible with acceptable perioperative, functional, and short-term oncologic outcomes.
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Affiliation(s)
- Gopal N Gupta
- 1 Department of Urology, Loyola University Medical Center , Maywood, Illinois
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Volkin D, Yerram N, Ahmed F, Lankford D, Baccala A, Gupta GN, Hoang A, Nix J, Metwalli AR, Lang DM, Bratslavsky G, Linehan WM, Pinto PA. Partial adrenalectomy minimizes the need for long-term hormone replacement in pediatric patients with pheochromocytoma and von Hippel-Lindau syndrome. J Pediatr Surg 2012; 47:2077-82. [PMID: 23164001 PMCID: PMC3846393 DOI: 10.1016/j.jpedsurg.2012.07.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/19/2012] [Accepted: 07/04/2012] [Indexed: 12/14/2022]
Abstract
PURPOSE Children with von Hippel-Lindau syndrome (VHL) are at an increased risk for developing bilateral pheochromocytomas. In an effort to illustrate the advantage of partial adrenalectomy (PA) over total adrenalectomy in children with VHL, we report the largest single series on PA for pediatric patients with VHL, demonstrating a balance between tumor removal and preservation of adrenocortical function. METHODS From 1994 to 2011, a prospectively maintained database was reviewed to evaluate 10 pediatric patients with hereditary pheochromocytoma for PA. Surgery was performed if there was clinical evidence of pheochromocytoma and if normal adrenocortical tissue was evident on preoperative imaging and/or intraoperative ultrasonography. Perioperative data were collected, and patients were observed for postoperative steroid use and tumor recurrence. RESULTS Ten pediatric patients with a diagnosis of VHL underwent 18 successful partial adrenalectomies (4 open, 14 laparoscopic). The median tumor size removed was 2.6 cm (range, 1.2-6.5 cm). Over a median follow-up of 7.2 years (range, 2.6-15.8 years), additional tumors in the ipsilateral adrenal gland were found in 2 patients. One patient underwent completion adrenalectomy, and 1 underwent a salvage PA with resection of the ipsilateral lesion. One patient required short-term steroid replacement therapy. At last follow-up, 7 patients had no radiographic or laboratory evidence of pheochromocytoma. CONCLUSION At our institution, PA is the preferred form of management for pheochromocytoma in the (VHL) pediatric population. This surgical approach allows for removal of tumor while preserving adrenocortical function and minimizing the adverse effects of long-term steroid replacement on puberty and quality of life.
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Affiliation(s)
- Dmitry Volkin
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892-1210, USA
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Adrenal cortex-sparing surgery for bilateral multiple pheochromocytomas in a patient with von hippel-lindau disease. Case Rep Med 2012; 2012:659104. [PMID: 23093973 PMCID: PMC3474994 DOI: 10.1155/2012/659104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 09/18/2012] [Accepted: 09/24/2012] [Indexed: 11/22/2022] Open
Abstract
Pheochromocytomas can be a part of familial neoplastic syndromes, in which case they tend to be multiple and involve both adrenal glands. Therefore, sparing adrenocortical function represents a major concern while dealing with these hereditary lesions. Herein, we describe the clinical characteristics and the management strategy of a patient with von Hippel-Lindau (VHL) disease who had multiple, bilateral pheochromocytomas as well as bilateral renal masses, pancreatic masses, and a paracaval mass. Only a portion of the left adrenal gland has remained in situ after two consecutive open surgeries and a percutaneous radiofrequency ablation which have been performed to treat the various components of this syndrome. No adrenal or extra-adrenal pheochromocytoma recurrences have been detected during a follow-up period of more than 2 years. Pancreatic and adrenal functions were normal throughout the postoperative period and never necessitated any replacement therapy. Adrenal cortex-sparing surgery is a valid option for VHL disease patients who present with synchronous bilateral adrenal pheochromocytomas.
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Adrenal nodular hyperplasia in hereditary leiomyomatosis and renal cell cancer. J Urol 2012; 189:430-5. [PMID: 22982371 DOI: 10.1016/j.juro.2012.07.139] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 07/26/2012] [Indexed: 11/23/2022]
Abstract
PURPOSE The condition hereditary leiomyomatosis and renal cell carcinoma is characterized by cutaneous leiomyomas, uterine fibroids and aggressive papillary renal cell carcinoma. A number of our patients with hereditary leiomyomatosis and renal cell carcinoma had atypical adrenal nodules, which were further evaluated to determine whether these nodules were associated with hereditary leiomyomatosis and renal cell carcinoma. MATERIALS AND METHODS Patients with hereditary leiomyomatosis and renal cell carcinoma underwent a comprehensive clinical and genetic evaluation. We reviewed the clinical presentation, anatomical and functional imaging, endocrine evaluation, pathological examination and germline mutation testing results. RESULTS Of 255 patients with hereditary leiomyomatosis and renal cell carcinoma 20 (7.8%) had primary adrenal lesions, including 4 with bilateral adrenal lesions and 4 with multiple nodules. Two patients had adrenocorticotropic hormone independent hypercortisolism. A total of 27 adrenal lesions were evaluated. The imaging characteristics of 5 of these lesions (18.5%) were not consistent with adenoma by noncontrast computerized tomography criteria. Positron emission tomography was positive in 7 of 10 cases (70%). A total of 12 nodules were surgically resected from 10 adrenal glands. Pathological examination revealed macronodular adrenal hyperplasia in all specimens. CONCLUSIONS Unilateral and bilateral adrenal nodular hyperplasia was detected in a subset of patients with hereditary leiomyomatosis and renal cell carcinoma. A functional endocrine evaluation is recommended when an adrenal lesion is discovered. Imaging frequently reveals lesions that are not typical of adenomas and positron emission tomography may be positive. To date no patient has had adrenal malignancy, and active surveillance of hereditary leiomyomatosis and renal cell carcinoma adrenal nodules appears justified.
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Navigation with the use of intraoperative ultrasonography in videoscopic adrenal surgery. POLISH JOURNAL OF SURGERY 2012; 84:399-405. [PMID: 22985702 DOI: 10.2478/v10035-012-0067-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED The aim of the study was to assess the efficacy of intraoperative ultrasonography during videoscopic adrenalectomy. MATERIAL AND METHODS The study was conducted in patients undergoing extraperitoneal videoscopic adrenalectomy for adrenal tumours in the Department of Endocrine, General and Vascular Surgery of the Medical University in Łódź in 2008-2011. RESULTS The active group consisted of 20 patients in whom navigation with the use of intraoperative ultrasonography (IOUS) was used in the course of surgery. The comparison group consisted of 46 patients operated without the use of IOUS. In the active group, we managed to obtain a shorter time of surgery by almost 20 min (89.44 ± 27.11 min vs 109.12 ± 33.88 min; p=0.034) and a shorter lesion access time by more than 15 min (28.61 ± 14.93 min vs 45.98 ± 20.44 min; p=0.002). Intraoperative blood loss was also significantly lower in the active group (86.11 ± 157 ml vs 169.27 ± 201.04 ml; p=0.037). In contrast, the use of IOUS did not affect the hospitalisation time (4.39 ± 3.27 days vs 3.83 ± 3.67 days; p=0.227), the rate of intraoperative complications (0/18 vs 2/41; p=1) and the conversion rate (2/20 - 10% vs 5/46 - 10.87%; p=1). CONCLUSIONS 1. Intraoperative ultrasonography is useful for determining the tumour relationship with the surrounding anatomical structures. 2. Intraoperative ultrasonography is a useful technique in the assessment of adrenal tumour infiltration of the surrounding tissues. 3. This technique facilitates finding the pathological lesion, shortening the time of access to the tumour and procedure duration (thus reducing the burden for the patient). 4. Reduced blood loss was also obtained owing to the use of IOUS.
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Agcaoglu O, Aliyev S, Karabulut K, Mitchell J, Siperstein A, Berber E. Robotic versus laparoscopic resection of large adrenal tumors. Ann Surg Oncol 2012; 19:2288-94. [PMID: 22396002 DOI: 10.1245/s10434-012-2296-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Indexed: 12/15/2022]
Abstract
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≥5 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.
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Affiliation(s)
- Orhan Agcaoglu
- Division of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Abstract
PURPOSE OF REVIEW We review the development of robotic adrenalectomy over the last decade, focusing on specific technical advances in the last 18 months. RECENT FINDINGS The learning curve for robotic adrenalectomy, after which conversion rates and operative times significantly decrease, is more than 20 cases even in surgeons with extensive laparoscopic experience. Two new uses of the robot to extend traditional laparoscopic adrenalectomy have been highlighted in recent studies. Posterior retroperitoneoscopic adrenalectomy can be aided by robotic assistance, particularly in patients whose adrenal gland is located well superior to the 12th rib, on the anterior surface of the kidney, or in the renal hilum. Robotic assistance has also enabled cortical-sparing adrenalectomy which may obviate the need for steroid hormone replacement in patients with multiple or bilateral tumors. SUMMARY Robot-assisted adrenalectomy can extend the capabilities of traditional laparoscopy, particularly in regard to performing posterior retroperitoneal and subtotal adrenalectomies.
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Current World Literature. Curr Opin Oncol 2012; 24:109-14. [DOI: 10.1097/cco.0b013e32834f4ea3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Partial adrenalectomy: when, where, and how? Considerations on technical aspect and indications to surgery. Eur Surg 2011. [DOI: 10.1007/s10353-011-0034-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Genc V, Agcaoglu O, Berber E. Robotic endocrine surgery: technical details and review of the literature. J Robot Surg 2011; 6:85-97. [PMID: 27628272 DOI: 10.1007/s11701-011-0298-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 07/14/2011] [Indexed: 11/25/2022]
Abstract
Over the last decade, robotic technology has been used in multiple general surgical procedures. Endocrine surgeons have embraced this technology and subsequently transformed neck operations into more cosmetically acceptable procedures and improved ergonomics. Technical details of various robotic endocrine surgical procedures have recently been described. The aim of this review is to illustrate these technical details and analyze the current data to propose an evidence-based approach to robotic endocrine surgery.
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Affiliation(s)
- Volkan Genc
- Department of Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Orhan Agcaoglu
- Division of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, 9500 Euclid Avenue/F20, Cleveland, OH, 44195, USA
| | - Eren Berber
- Division of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, 9500 Euclid Avenue/F20, Cleveland, OH, 44195, USA.
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Asher KP, Gupta GN, Boris RS, Pinto PA, Linehan WM, Bratslavsky G. Robot-assisted laparoscopic partial adrenalectomy for pheochromocytoma: the National Cancer Institute technique. Eur Urol 2011; 60:118-24. [PMID: 21507561 PMCID: PMC3109214 DOI: 10.1016/j.eururo.2011.03.046] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 03/25/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Partial adrenalectomy has recently been advocated to preserve unaffected adrenal tissue during resection of pheochromocytoma. OBJECTIVE To describe a robot-assisted laparoscopic partial adrenalectomy (RALPA) technique and to report on early functional and oncologic outcomes. DESIGN, SETTING, AND PARTICIPANTS From 2007 to 2010, 15 RALPA were performed on 12 consecutive patients with pheochromocytoma. Follow-up data of >1 yr are available on 11 procedures. Median follow-up for the entire cohort was 17.3 mo (range: 6-45). SURGICAL PROCEDURE Positioning and port placement is designed for adequate reach and visualization of the upper retroperitoneum. The plane between the adrenal cortex and pheochromocytoma pseudocapsule is identified visually and with laparoscopic ultrasound. The tumor is dissected away from normal adrenal cortex, preserving normal adrenal tissue. MEASUREMENTS Preoperative, perioperative, pathologic, and functional outcomes data were analyzed. RESULTS AND LIMITATIONS Fourteen of 15 cases were completed robotically. Among 15 procedures, 4 were performed on a solitary adrenal gland. Four cases required resection of multiple tumors (up to six) with two performed in a solitary gland. The mean age of the patients was 30 yr, and the mean body mass index was 27. The mean operative time was 163 min, the median estimated blood loss was 161 ml, and the median tumor size was 2.7 cm (range: 1.3-5.5). There was one conversion to an open procedure in a patient requiring reoperation on a solitary adrenal gland. One patient who underwent RALPA on a solitary adrenal gland required postoperative steroid supplementation at last follow-up. At a median follow-up of 17.3 mo (range: 6-45), there were no recurrences or metastatic events. Study limitations include small sample size and short follow-up. CONCLUSIONS RALPA for the treatment of pheochromocytoma is feasible and safe and provides encouraging functional and oncologic outcomes, even in patients with a solitary adrenal lesion or multiple ipsilateral lesions.
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Affiliation(s)
- Kevin P Asher
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-1107, USA
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