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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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2
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Davey MG, Ryan ÉJ, Donlon NE, Ryan OK, Al Azzawi M, Boland MR, Kerin MJ, Lowery AJ. Comparing surgical outcomes of approaches to adrenalectomy - a systematic review and network meta-analysis of randomised clinical trials. Langenbecks Arch Surg 2023; 408:180. [PMID: 37145303 PMCID: PMC10163131 DOI: 10.1007/s00423-023-02911-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND No randomised clinical trials (RCTs) have simultaneously compared the safety of open (OA), transperitoneal laparoscopic (TLA), posterior retroperitoneal (PRA), and robotic adrenalectomy (RA) for resecting adrenal tumours. AIM To evaluate outcomes for OA, TLA, PRA, and RA from RCTs. METHODS A NMA was performed according to PRISMA-NMA guidelines. Analysis was performed using R packages and Shiny. RESULTS Eight RCTs with 488 patients were included (mean age: 48.9 years). Overall, 44.5% of patients underwent TLA (217/488), 37.3% underwent PRA (182/488), 16.4% underwent RA (80/488), and just 1.8% patients underwent OA (9/488). The mean tumour size was 35 mm in largest diameter with mean sizes of 44.3 mm for RA, 40.9 mm for OA, 35.5 mm for TLA, and 34.4 mm for PRA (P < 0.001). TLA had the lowest blood loss (mean: 50.6 ml), complication rates (12.4%, 14/113), and conversion to open rates (1.3%, 2/157), while PRA had the shortest intra-operative duration (mean: 94 min), length of hospital stay (mean: 3.7 days), lowest visual analogue scale pain scores post-operatively (mean: 3.7), and was most cost-effective (mean: 1728 euros per case). At NMA, there was a significant increase in blood loss for OA (mean difference (MD): 117.00 ml (95% confidence interval (CI): 1.41-230.00)) with similar blood loss observed for PRA (MD: - 10.50 (95% CI: - 83.40-65.90)) compared to TLA. CONCLUSION LTA and PRA are important contemporary options in achieving favourable outcomes following adrenalectomy. The next generation of RCTs may be more insightful for comparison surgical outcomes following RA, as this approach is likely to play a future role in minimally invasive adrenalectomy. PROSPERO REGISTRATION CRD42022301005.
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Affiliation(s)
- Matthew G Davey
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91YR71, Ireland.
- Department of Surgery, Galway University Hospitals, Galway, H91YR71, Republic of Ireland.
| | - Éanna J Ryan
- Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland
| | - Noel E Donlon
- Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland
| | - Odhrán K Ryan
- Surgical Professorial Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland
| | - Mohammed Al Azzawi
- Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland
| | - Michael R Boland
- Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland
| | - Michael J Kerin
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91YR71, Ireland
| | - Aoife J Lowery
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91YR71, Ireland
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3
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Raffaelli M, Gallucci P, Voloudakis N, Pennestrì F, De Cicco R, Arcuri G, De Crea C, Bellantone R. The new robotic platform Hugo™ RAS for lateral transabdominal adrenalectomy: a first world report of a series of five cases. Updates Surg 2023; 75:217-225. [PMID: 36333563 PMCID: PMC9834370 DOI: 10.1007/s13304-022-01410-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
Robotic assisted surgery is the most rapidly developing field of minimally invasive surgery. Its wide diffusion has led to the development and standardization of robotic-assisted approaches also for adrenalectomy. In this study, we present the first five robotic-assisted lateral transabdominal adrenalectomies performed with the new Hugo RAS™ system (Medtronic, Minneapolis, MN, USA). After an official training course of the surgical team, five consecutive patients scheduled for unilateral adrenalectomy, underwent robotic-assisted operations in our institution. Patients that were candidates for partial adrenalectomy were excluded. A description of the operating theatre, robotic arms and docking setup is provided. Four female and one male patient underwent lateral transabdominal adrenalectomy, three for lesions on the left side and two on the right. Median lesion size was 3.9 cm (range: 30-90) and preoperative diagnosis was Cushing's syndrome in three patients, an adrenal cystic lesion and a pheochromocytoma. The median docking time was 5 min (range: 5-8) and the median console time was 55 min (range: 29-108). Procedures were performed without intraoperative complications and no conversions or additional ports were needed. System's function and docking were uneventful. Based on our initial experience, adrenalectomy with the Hugo™ system is feasible. This study provides technical notes for other centres that wish to perform robotic-assisted adrenalectomies with the Hugo™ RAS as well as general information and our preliminary insights on this new platform.
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Affiliation(s)
- Marco Raffaelli
- U.O. Chrirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Pierpaolo Gallucci
- U.O. Chrirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Nikolaos Voloudakis
- U.O. Chrirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Pennestrì
- U.O. Chrirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberto De Cicco
- U.O Anestesie delle Chirurgie Generali e dei Trapianti, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Arcuri
- U.O. Direzione Tecnica e Innovazione - Tecnologia Sanitaria, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Carmela De Crea
- U.O. Chrirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rocco Bellantone
- U.O. Chrirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
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4
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Selvaraj N, Pooleri GK, Addla SK, Raghavan D, Govindaswamy TG, Balakrishnan AK, Sivaraman A, Jain N, Kandasamy SG, Ragavan N. Robot assisted laparoscopic adrenalectomy: Should this be the new standard? Urologia 2022; 89:430-436. [DOI: 10.1177/03915603221097166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Minimal invasive surgeries (MIS) for large size adrenal tumors are still debatable. The objective is to evaluate the contemporary peri- and post-operative outcomes of patients undergoing (open = OA, laparoscopic = LA, and robotic = RA) adrenalectomies in three institutions. Materials and methods: Retrospectively gathered peri- and post-operative data of 235 patients, underwent adrenalectomy at three Institutions over a 7-year period (2013–2020) were analyzed. All patients underwent thorough radiological and endocrine workup. Results: Two hundred and thirty five patients who underwent adrenalectomy (OA ( n = 29), LA ( n = 146), and RA ( n = 60)) were assessed. OA ( n = 29) versus Minimally invasive surgery ( n = 206) showed significant differences (median, p value) in larger tumour size, cm (9.4 vs 5, ( p = 0.0001)), longer operative time, mins (240 vs 100, ( p = 0.0001)), longer hospital stay, days (8 vs 3,( p = .0001)), Higher readmission rates (14% vs 1.9%), higher blood loss, ml (400 vs 100, ( p = 0.0001)) requiring blood transfusion (14% vs 4.3%) ( p = 0.03), higher intraoperative complication (21% vs 6%) ( p = 0.0004), and post op complications (17% vs 5.3%) ( p = 0.01). Amongst the MIS (RA vs LA), RA appeared be have better outcomes in terms of shorter operative time, less blood loss and less intra operative complications with a p value <0.05. These results were consistent for the assessment of patients who had ⩾6 cm tumor size. The postoperative complication rates were lowest with RA (3.3%) compared to OA (17%) and LA (6.1%). Conclusions: Contemporary practice of adrenalectomy shows that robotic adrenalectomy is safe and effective irrespective of the tumor size.
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Affiliation(s)
- Nivash Selvaraj
- Department of Urology, Apollo Main Hospitals, Chennai, India
| | | | - Sanjai Kumar Addla
- Department of Urooncology, Apollo Cancer Institutes, Jubilee Hills, Hyderabad, India
| | - Deepak Raghavan
- Department of Urology, Apollo Main Hospitals, Chennai, India
| | | | | | | | - Nitesh Jain
- Department of Urology, Apollo Main Hospitals, Chennai, India
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5
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De Crea C, Arcuri G, Pennestrì F, Paolantonio C, Bellantone R, Raffaelli M. Robotic adrenalectomy: evaluation of cost-effectiveness. Gland Surg 2020; 9:831-839. [PMID: 32775276 DOI: 10.21037/gs.2020.03.44] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Laparoscopic adrenalectomy (LA) is the preferred treatment option for adrenal lesions, considering the improved patients outcomes, due to the reduced postoperative morbidity and postoperative pain, the faster recovery and the shorter length of hospital stay. The widespread diffusion of robotic technology led to the development and standardization of robot-assisted approach to adrenalectomy. However, to date, no clear benefit from the use of the robot-assisted approach has been found. The higher costs remain an important drawback and limit the implementation of robot-assisted adrenalectomy (RA) programs. This review summarizes the current available data regarding RA including its operative outcomes, advantages and drawbacks in comparison with conventional LA, evaluating its cost-effectiveness.
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Affiliation(s)
- Carmela De Crea
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giovanni Arcuri
- UOC Tecnologie Sanitarie, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Francesco Pennestrì
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Chiara Paolantonio
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Rocco Bellantone
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Marco Raffaelli
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Roma, Italy
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6
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Sforza S, Minervini A, Tellini R, Ji C, Bergamini C, Giordano A, Lu Q, Chen W, Zhang F, Ji H, Di Maida F, Prosperi P, Masieri L, Carini M, Valeri A, Guo H. Perioperative outcomes of robotic and laparoscopic adrenalectomy: a large international multicenter experience. Surg Endosc 2020; 35:1801-1807. [PMID: 32328826 DOI: 10.1007/s00464-020-07578-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/17/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The aim of the study was to describe the surgical outcomes of a retrospective series of consecutive patients treated with laparoscopic and robotic approach for adrenal masses in two tertiary referral centers. METHODS We retrospectively gathered data of 477 patients submitted to adrenalectomy performed at two Institutions from March 2008 to February 2018 by six highly experienced surgeons. We excluded from the analysis 43 patients that had an open approach for tumors or for anesthetic contraindications to minimally invasive surgery (MIS). Patients were selected for surgery after a radiologic and an endocrinology work up. Preoperative, perioperative and postoperative data were recorded. RESULTS Overall, 477 patients were included in the study. The robotic and the laparoscopic group included 110 and 367 patients, respectively. The preoperative characteristics were similar in both groups except for ASA score with a median (IQR) of 3 and 2 in the robotic and in the laparoscopic group, respectively (p = 0.03). Tumor size of adrenal tumors treated robotically (4, IQR 2.6-6 cm) was significantly larger than those treated laparoscopically (3, IQR 2.3-4.1 cm) (p = 0.01). The intraoperative complication rates were similar between robotic and laparoscopic groups (6.3% and 6%, respectively). The postoperative complication rate was 5.4% for robotic group and similarly 3.5% for laparoscopic adrenalectomy strategy. We analyzed the tumor ≥ 6 cm, with 29 patients in the robotic group and 43 in the laparoscopic one, with an overall complication rate of 19.5%. At multivariable analyses tumor size (OR 1.287; CI 1.128-1.468; p < 0.001) was the only independent predictor of overall complication. CONCLUSION Adrenal tumors can be safely treated either by robotic or laparoscopic strategy. MIS seems to be feasible also in larger adrenal masses (≥ 6 cm). Tumor size represents the only predictive factors for overall complication.
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Affiliation(s)
- Simone Sforza
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, San Luca Nuovo, Largo Brambilla 3, 50134, Florence, Italy.
| | - Andrea Minervini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, San Luca Nuovo, Largo Brambilla 3, 50134, Florence, Italy
| | - Riccardo Tellini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, San Luca Nuovo, Largo Brambilla 3, 50134, Florence, Italy
| | - Changwei Ji
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
| | | | | | - Qun Lu
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
| | - Wei Chen
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
| | - Feifei Zhang
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
| | - Hao Ji
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
| | - Fabrizio Di Maida
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, San Luca Nuovo, Largo Brambilla 3, 50134, Florence, Italy
| | - Paolo Prosperi
- Emergency Surgery Unit, Careggi Hospital, Florence, Italy
| | - Lorenzo Masieri
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, San Luca Nuovo, Largo Brambilla 3, 50134, Florence, Italy
| | - Marco Carini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, San Luca Nuovo, Largo Brambilla 3, 50134, Florence, Italy
| | - Andrea Valeri
- Emergency Surgery Unit, Careggi Hospital, Florence, Italy
| | - Hongqian Guo
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
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7
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Perivoliotis K, Baloyiannis I, Sarakatsianou C, Tzovaras G. Comparing the efficacy and safety of laparoscopic and robotic adrenalectomy: a meta-analysis and trial sequential analysis. Langenbecks Arch Surg 2020; 405:125-135. [PMID: 32133562 DOI: 10.1007/s00423-020-01860-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/27/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE A systematic literature review and a meta-analysis were designed and conducted, in order to provide an up-to-date comparison of the robotic (RA) and laparoscopic (LA) adrenalectomy in terms of perioperative efficacy and safety. METHODS The present meta-analysis was completed in accordance with the guidelines provided by the PRISMA study group and the Cochrane Handbook for Systematic Reviews of Interventions. The electronic scholar databases (Medline, Web of Science, Scopus) were screened. For the reduction of type I errors, a trial sequential analysis (TSA) was performed. RESULTS Overall, 21 studies and 2997 patients were included in this study. RA was associated with a significantly lower open conversion rate (OR: 1.79; 95%CI: 1.10, 2.92) and length of hospitalization (LOS WMD: 0.52; 95%CI: 0.2, 0.84). Marginal results regarding blood loss were recorded (WMD: 2.02; 95%CI: 0.0, 4.03). TSA could not validate the superiority of RA in open conversion rate and blood loss. LA and RA were similar in terms of operative duration (P = 0.18) and positive margin (P = 0.81), complications (P = 0.94) and mortality rate (P = 0.45). CONCLUSIONS Even though RA and LA were equivalent regarding perioperative safety, RA was associated with a favorable LOS.
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Affiliation(s)
| | - Ioannis Baloyiannis
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece.
| | - Chamaidi Sarakatsianou
- Department of Anesthesiology, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - George Tzovaras
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
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8
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Zhao J, Ma W, Xie J, Dai J, Huang X, Fang C, He W, Sun F. Laparoscopic Treatment of Large Adrenal Tumor is Safe and Effective? A Single Center Experiences. J INVEST SURG 2020; 34:957-962. [PMID: 32036714 DOI: 10.1080/08941939.2020.1719243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The comparisons between open surgery and minimally invasive surgery for treatment of large adrenal tumor (LAT) are still lacking. In this study, we attempted to explore the safety and effectiveness of laparoscopic treatment of LAT by comparing the outcomes between open adrenalectomy (OA) and laparoscopic adrenalectomy (LA). METHODS From 2003 to 2018, 78 LAT patients underwent tumor resection by OA or LA method at a single academic institution. Data were retrospectively collected and analyzed. RESULTS The median largest diameter of LAT was 10.0 (IQR 9.0-13.4) cm. The median operation time in OA group was 215 (IQR 180-240) min versus 180 (IQR 135-245) min in LA group (P = 0.042). The median blood loss in OA group was 1000 (IQR 625-1500) ml versus 200 (IQR 100-700) ml in LA group (P < 0.001). The median Clavien-Dindo score in OA group was 2 (IQR 2-4) versus 0 (IQR 0-4) in LA group (P = 0.035). On univariate and multivariate analysis, the largest diameter of tumor was significantly associated with operation time, blood loss, and recovery time (P < 0.05). CONCLUSIONS Laparoscopic treatment of LAT was found to be safe and feasible in experienced hands and can replace open surgeries in most cases.
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Affiliation(s)
- Juping Zhao
- Department of Urology, Shanghai JiaoTong University School of Medicine, Ruijin Hospital, Shanghai, China
| | - Wenming Ma
- Department of Urology, Shanghai JiaoTong University School of Medicine, Ruijin Hospital, Shanghai, China
| | - Jialing Xie
- Department of Pathology, Shanghai JiaoTong University School of Medicine, Ruijin Hospital, Shanghai, China
| | - Jun Dai
- Department of Urology, Shanghai JiaoTong University School of Medicine, Ruijin Hospital, Shanghai, China
| | - Xin Huang
- Department of Urology, Shanghai JiaoTong University School of Medicine, Ruijin Hospital, Shanghai, China
| | - Chen Fang
- Department of Urology, Shanghai JiaoTong University School of Medicine, Ruijin Hospital, Shanghai, China
| | - Wei He
- Department of Urology, Shanghai JiaoTong University School of Medicine, Ruijin Hospital, Shanghai, China
| | - Fukang Sun
- Department of Urology, Shanghai JiaoTong University School of Medicine, Ruijin Hospital, Shanghai, China
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9
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Nomine-Criqui C, Demarquet L, Schweitzer ML, Klein M, Brunaud L, Bihain F. Robotic adrenalectomy: when and how? Gland Surg 2020; 9:S166-S172. [PMID: 32175258 DOI: 10.21037/gs.2019.12.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Currently, laparoscopic adrenalectomy is considered as the preferred technique to manage adrenal tumors. However, there are no prospective randomized studies evaluating this strategy. With the recent advances in surgical equipment and the widespread of robotic technology, a robotic approach is considered as an interesting option in some medical centers. This approach seems to be feasible and safe but high-level evidence of its benefits is still lacking. This review summarizes indications, advantages and drawbacks of robotic adrenalectomy and describes its surgical technique.
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Affiliation(s)
- Claire Nomine-Criqui
- Unit of Metabolic, Endocrine, and Thyroid Surgery (UMET), Department of Visceral and Metabolic Surgery, Hospital Brabois Adultes, CHRU Nancy, University of Lorraine, Nancy, France
| | - Lea Demarquet
- Department of Endocrinology, Diabetology and Nutrition, CHU Nancy, University of Lorraine, Nancy, France
| | - Marie Laure Schweitzer
- Department of Endocrinology, Diabetology and Nutrition, CHU Nancy, University of Lorraine, Nancy, France
| | - Marc Klein
- Department of Endocrinology, Diabetology and Nutrition, CHU Nancy, University of Lorraine, Nancy, France
| | - Laurent Brunaud
- Unit of Metabolic, Endocrine, and Thyroid Surgery (UMET), Department of Visceral and Metabolic Surgery, Hospital Brabois Adultes, CHRU Nancy, University of Lorraine, Nancy, France.,INSERM U1256, Nutrition, Genetics, Environmental Risks, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Florence Bihain
- Unit of Metabolic, Endocrine, and Thyroid Surgery (UMET), Department of Visceral and Metabolic Surgery, Hospital Brabois Adultes, CHRU Nancy, University of Lorraine, Nancy, France
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