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Kim K, Park D, Oh MY, Chai YJ, Kim HY. Safety and surgical outcomes of robotic adrenalectomy from a 15-year experience at a single institution. Sci Rep 2024; 14:12174. [PMID: 38806567 PMCID: PMC11133357 DOI: 10.1038/s41598-024-63105-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/24/2024] [Indexed: 05/30/2024] Open
Abstract
Robotic adrenalectomy (RA) has gained significant popularity in the management of adrenal gland diseases. We report our experience at a single tertiary institution and evaluate the safety and surgical outcomes of RA. The data of 122 consecutive patients who underwent RA from October 2009 to December 2022 at Korea University Anam Hospital (Seoul, Korea) were reviewed. There were no perioperative complications. Clinicopathological features and surgical outcomes were retrospectively analyzed through complete chart reviews. Noteworthy findings include the influence of sex, tumor size, and body mass index on operation time, with the female and small tumor groups exhibiting shorter operation times (P = 0.018 and P = 0.009, respectively). Pheochromocytoma was identified as a significant independent risk factor for a longer operation time in the multivariate analysis [odds ratio (OR), 3.709; 95% confidence interval (CI), 1.127-12.205; P = 0.031]. A temporal analysis revealed a decreasing trend in mean operation times across consecutive groups, reflecting a learning curve associated with RA adoption. RA is a safe and effective operative technique alternative to laparoscopic adrenalectomy that has favorable surgical outcomes and enhances the convenience of the operation.
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Affiliation(s)
- Kwangsoon Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dawon Park
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Moon Young Oh
- Department of Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Young Jun Chai
- Department of Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hoon Yub Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea.
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Conzo G, Patrone R, Flagiello L, Catauro A, Conzo A, Cacciatore C, Mongardini FM, Cozzolino G, Esposito R, Pasquali D, Bellastella G, Esposito K, Docimo L. Impact of Current Technology in Laparoscopic Adrenalectomy: 20 Years of Experience in the Treatment of 254 Consecutive Clinical Cases. J Clin Med 2023; 12:4384. [PMID: 37445419 DOI: 10.3390/jcm12134384] [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: 05/13/2023] [Revised: 06/22/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Laparoscopic adrenalectomy (LA), which avoids large abdomen incisions, is considered the gold standard technique for the treatment of benign small- and medium-size adrenal masses (<6 cm) and weighing < 100 g. A trascurable mortality and morbidity rate, short hospitalization and patient rapid recovery are the main advantages compared to traditional surgery. During the past decade, a new surgical technology has been developed that expedites a "clipless" adrenalectomy. Here, the authors analyze a clinical series of 254 consecutive patients who were affected by adrenal gland neoplasms and underwent LA by the transabdominal lateral approach over the two last decades. A literature review is also presented. METHODS Preoperative, intraoperative and postoperative data from 254 patients who underwent LA between January 2003 and December 2022 were retrospectively collected and reviewed. Diagnosis was obtained on the basis of clinical examination, laboratory values and imaging techniques. Doxazosin was preoperatively administered in the case of pheochromocytoma (PCC) while spironolactone and potassium were employed to treat Conn's disease. The same surgeon (CG) performed all the LA and utilized the same laparoscopic transabdominal lateral approach. Different dissection tools-ultrasonic, bipolar or mixed scissors-and hemostatic agents were used during this period. The following results were obtained: 254 patients were included in the study; functioning tumors were diagnosed in 155 patients, 52 patients were affected by PCCs, 55 by Conn's disease, 48 by Cushing's disease. Surgery mean operative time was 137.33 min (range 100-180 min) during the learning curve adrenalectomies and 98.5 min (range 70-180) in subsequent procedures. Mean blood loss was respectively 160.2 mL (range 60-280) and 96.98 mL (range 50-280) in the first 30 procedures and the subsequent ones. Only three conversions (1.18%) to open surgery occurred. No mortality or postoperative major complications were observed, while minor complications occurred in 19 patients (3.54%). In 153 out of 155 functioning neoplasms, LA was effective in the normalization of the endocrine profile. According to our experience, a learning curve consisting of 30 cases was identified. In fact, a lower operative time and a lower complication rate was reported following 30 LA. CONCLUSIONS LA is a safe procedure, even for masses larger than 6 cm and PCCs. Undoubtedly, the development of surgical technology has made it possible reducing operative times, performing a "clipless" adrenalectomy and extending the indications in the treatment of more complex patients. A multidisciplinary team, in referral high-volume centers, is recommended in the management of adrenal pathology. A 30-procedure learning curve is necessary to improve surgical outcomes.
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Affiliation(s)
- Giovanni Conzo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Renato Patrone
- Dieti Department, University of Naples Federico II, 80100 Naples, Italy
- Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy
| | - Luigi Flagiello
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Antonio Catauro
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Alessandra Conzo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Chiara Cacciatore
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Federico Maria Mongardini
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Giovanni Cozzolino
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Rosetta Esposito
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Daniela Pasquali
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80100 Naples, Italy
| | - Giuseppe Bellastella
- Division of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Second University of Naples, 80138 Naples, Italy
| | - Katherine Esposito
- Diabetes Unit, Department of Clinical and Experimental Medicine, Second University of Naples, 80138 Naples, Italy
| | - Ludovico Docimo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
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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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Collins RA, Wang TS, Dream S, Solórzano CC, Kiernan CM. Adoption of Robotic Adrenalectomy: A Two-Institution Study of Surgeon Learning Curve. Ann Surg Oncol 2023:10.1245/s10434-023-13406-6. [PMID: 37040047 DOI: 10.1245/s10434-023-13406-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/08/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Robotic adrenalectomy is feasible and safe, yet concerns over increased operative times and the learning curve (LC) for proficiency have limited its adoption. This study aimed to assess the LC for robotic adrenalectomy. METHODS This is a two-institution retrospective review of consecutive unilateral minimally invasive adrenalectomies performed by four high-volume adrenal surgeons between 2007 and 2022. Two surgeons transitioned from laparoscopic to robotic adrenalectomy, and two surgeons adopted the approach, with proctoring, after completion of fellowship training without robotic experience. Operative time and complications were analyzed. Multivariable regression was used to identify factors associated with operative time. The number of cases required to overcome the LC was determined using the LC-cumulative-sum (LC-CUSUM) analysis. RESULTS Of 457 adrenalectomies, 182 (40%) were laparoscopic and 275 (60%) robotic. The robotic approach was associated with shorter median operative time (106 vs 119 min; p = 0.002), fewer complications (6% vs 13%; p = 0.018), and fewer conversions to open adrenalectomy (1% vs 4%; p = 0.030), with no difference between the senior and junior surgeons. On adjusted analysis, factors associated with increased operative time were male sex (p < 0.001), BMI > 30 kg/m2 (p < 0.001), and higher gland weight (p < 0.001). The LC-CUSUM analysis showed proficiency after 8-29 procedures. Compared with the first 10 cases, there was a mean reduction in operative time of 14 min after 10-20 cases, 28 min after 20-30 cases, and 29 min after > 30 cases, regardless of surgeon experience. DISCUSSION With dedicated teams and proctoring, robotic adrenalectomy can be safely adopted at high-volume centers with a minimal LC.
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Affiliation(s)
- Reagan A Collins
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA
| | - Tracy S Wang
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sophie Dream
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Carmen C Solórzano
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Colleen M Kiernan
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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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: 27] [Impact Index Per Article: 27.0] [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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Dong J, Ji R, Liu G, Zhou J, Wang H, Xu W, Ji Z, Cui L. Feasibility, safety and effectiveness of robot-assisted retroperitoneal partial adrenalectomy with a new robotic surgical system: A prospective clinical study. Front Surg 2023; 10:1071321. [PMID: 36911621 PMCID: PMC9992795 DOI: 10.3389/fsurg.2023.1071321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 02/07/2023] [Indexed: 02/24/2023] Open
Abstract
Objectives To evaluate the feasibility, safety and efficacy of the newly developed KD-SR-01® robotic system for retroperitoneal partial adrenalectomy. Subjects and Methods We prospectively enrolled patients with benign adrenal mass undergoing KD-SR-01® robot-assisted partial adrenalectomy in our institution from November 2020 to May 2022. Surgeries were performed via a retroperitoneal approach using the KD-SR-01® robotic system. The baseline, perioperative and short-term follow-up data were prospectively collected. A descriptive statistical analysis was performed. Results A total of 23 patients were enrolled, including nine (39.1%) patients with hormone-active tumors. All patients received partial adrenalectomy via the retroperitoneal approach without conversions to other procedures. The median operative time was 86.5 min [interquartile range (IQR), 60.0-112.5] and the median estimated blood loss was 50 ml (range, 20-400). Three (13.0%) patients developed Clavien-Dindo grade I-II postoperative complications. The median postoperative stay was 4.0 days (IQR, 3.0-5.0). All surgical margins were negative. The short-term follow-up demonstrated complete or partial clinical and biochemical success as well as absence of imaging recurrence in all patients with hormone-active tumors. Conclusions Initial results illustrate that the KD-SR-01® robotic system is safe, feasible and effective for the surgical management of benign adrenal tumors.
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Affiliation(s)
- Jie Dong
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ruoyu Ji
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Guanghua Liu
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingmin Zhou
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Huizhen Wang
- Department of Operation Room, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Weifeng Xu
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhigang Ji
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Liang Cui
- Department of Urology, Civil Aviation General Hospital, Civil Aviation Medical College of Peking University, Beijing, China
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Dogrul AB, Cennet O, Dincer AH. Minimally invasive techniques in benign and malignant adrenal tumors. World J Clin Cases 2022; 10:12812-12821. [PMID: 36569018 PMCID: PMC9782958 DOI: 10.12998/wjcc.v10.i35.12812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/04/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
Minimally invasive adrenalectomy has become the main treatment modality for most adrenal lesions. Both laparoscopic transabdominal and retroperitoneoscopic approaches are safe and feasible options, each with respective advantages, including better surgical outcomes, fewer complications, and faster recovery over open adrenalectomy. While open surgery remains a valid modality in treatment of adrenocortical cancer in the presence of some findings such as invasion, robotic platforms, and minimally invasive surgery have gained popularity as technology continues to evolve. Organ preservation during adrenalectomy is feasible in some conditions to prevent adrenal insufficiency. Ablative technologies are increasingly utilized in benign and malignant tumors, including the adrenal gland, with various outcomes. A multidisciplinary team, an experienced surgeon, and a high-volume center are recommended for any surgical approaches and management of adrenal lesions. This review article evaluated recent findings and current evidence on minimally invasive adrenalectomy.
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Affiliation(s)
- Ahmet Bulent Dogrul
- Department of General Surgery, Hacettepe University Faculty of Medicine, Hacettepe University, Ankara 06100, Turkey
| | - Omer Cennet
- Department of General Surgery, Hacettepe University Faculty of Medicine, Hacettepe University, Ankara 06100, Turkey
| | - Anıl Hilmi Dincer
- Department of General Surgery, Hacettepe University Faculty of Medicine, Hacettepe University, Ankara 06100, Turkey
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Robotic Versus Laparoscopic Adrenalectomy: The European Experience. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00338-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Choi YS, Lee JS, Yi JW. Comparative Analysis of Laparoscopic and Robotic Transperitoneal Adrenalectomy Performed at a Single Institution. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1747. [PMID: 36556949 PMCID: PMC9786224 DOI: 10.3390/medicina58121747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
Background and Objectives: Laparoscopic adrenalectomy (LA) is the standard surgical approach for adrenalectomy. At present, robotic adrenalectomy (RA) has been introduced at various hospitals. This study evaluated our initial experience with robotic adrenalectomy compared with conventional laparoscopic adrenalectomy. Materials and Methods: From October 2018 to March 2022, 56 adrenalectomies were performed by a single endocrine surgeon. Thirty-two patients underwent LA (LA group), and twenty-four patients underwent RA (RA group). Results: Patients in the RA group were significantly younger than those in the LA group (48.6 ± 9.7 years vs. 55.1 ± 11.4 years, p = 0.013). The RA group had a shorter operation time than the LA group (76.1 ± 28.2 min vs. 118.0 ± 54.3 min, p < 0.001). The length of hospital stay and postoperative pain level between the two groups were similar. There were no complications in the RA group. There was no significant difference in the pathologic diagnosis between the two groups. The cost of surgery was significantly higher in the RA group than in the LA group (5288.5 US dollars vs. 441.5 ± 136.8 US dollars, p < 0.001). Conclusions: In our initial experience, RA showed a shorter operation time than LA and no complications. RA could be a viable alternative surgical option for adrenalectomy, notwithstanding its higher cost.
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Affiliation(s)
| | | | - Jin Wook Yi
- Department of Surgery, Inha University Hospital, College of Medicine, Incheon 22332, Republic of Korea
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10
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De Crea C, Pennestrì F, Voloudakis N, Sessa L, Procopio PF, Gallucci P, Bellantone R, Raffaelli M. Robot-assisted vs laparoscopic lateral transabdominal adrenalectomy: a propensity score matching analysis. Surg Endosc 2022; 36:8619-8629. [PMID: 36190555 PMCID: PMC9613740 DOI: 10.1007/s00464-022-09663-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 09/18/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Laparoscopic adrenalectomy (LA) is the gold standard treatment for adrenal lesions. Robot-assisted adrenalectomy (RAA) is a safe approach, associated with higher costs in absence of clear-cut benefits. Several series reported some advantages of RAA over LA in challenging cases, but definitive conclusions are lacking. We evaluated the cost effectiveness and outcomes of robotic (R-LTA) and laparoscopic (L-LTA) approach for lateral transabdominal adrenalectomy in a high-volume center. METHODS Among 356 minimally invasive adrenalectomies (January 2012-August 2021), 286 were performed with a lateral transabdominal approach: 191 L-LTA and 95 R-LTA. The R-LTA and L-LTA patients were matched for lesion side and size, hormone secretion, and BMI with propensity score matching (PSM) analysis. Postoperative complications, operative time (OT), postoperative stay (POS), and costs were compared. RESULTS PSM analysis identified 184 patients, 92 in R-LTA and 92 in L-LTA group. The two groups were well matched. The median lesion size was 4 cm in both groups (p = 0.533). Hormonal hypersecretion was detected in 55 and 54 patients of R-LTA and L-LTA group, respectively (p = 1). Median OT was significantly longer in R-LTA group (90.0 vs 65.0 min) (p < 0.001). No conversion was registered. Median POS was similar (4.0 vs 3.0 days in the R-LTA and L-LTA) (p = 0.467). No difference in postoperative complications was found (p = 1). The cost margin analysis showed a positive income for both procedures (3137 vs 3968 € for R-LTA and L-LTA). In the multiple logistic regression analysis, independent risk factors for postoperative complications were hypercortisolism (OR = 3.926, p = 0.049) and OT > 75 min (OR = 8.177, p = 0.048). CONCLUSIONS The postoperative outcomes of R-LTA and L-TLA were similar in our experience. Despite the higher cost, RAA appears to be cost effective and economically sustainable in a high-volume center (60 adrenalectomies/year), especially if performed in challenging cases, including patients with large (> 6 cm) and/or functioning tumors.
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Affiliation(s)
- Carmela De Crea
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia Endocrina e dell'Obesità, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Francesco Pennestrì
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
- Centro di Ricerca in Chirurgia Endocrina e dell'Obesità, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy.
| | - Nikolaos Voloudakis
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Sessa
- Centro di Ricerca in Chirurgia Endocrina e dell'Obesità, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
- Centro Malattie Endocrine e Obesità, Fondazione Gemelli Giglio Cefalù, Cefalù, Palermo, Italy
| | - Priscilla Francesca Procopio
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia Endocrina e dell'Obesità, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Pierpaolo Gallucci
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Rocco Bellantone
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia Endocrina e dell'Obesità, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Marco Raffaelli
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia Endocrina e dell'Obesità, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
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11
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Comparison of the effectiveness and safety of robotic-assisted and laparoscopic in adrenalectomy: A systematic review and meta-analysis. Int J Surg 2022; 105:106853. [PMID: 36075556 DOI: 10.1016/j.ijsu.2022.106853] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/12/2022] [Accepted: 08/19/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the safety and effectiveness of robot-assisted adrenalectomy (RA) and laparoscopic adrenalectomy (LA). METHODS We performed a systematic review and cumulative meta-analysis of the primary outcomes of interest according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the Methodological Quality of Systematic Reviews) Guidelines. Five databases, including Medline, PubMed, Cochrane Library, Scopus, and Web of Science, were systematically searched. The search timeframe was set from the creation of the database to December 2021. RESULTS There were 26 studies including 2985 patients. Our study found that the robotic technique was superior to conventional laparoscopy for estimated blood loss (WMD = -18.25, 95% CI [-27.85, -8.65], P < 0.01), length of stay (WMD = -0.45, 95% CI [-0.57, -0.33], P < 0.01), and conversion to open (OR = 0.31, 95% CI [0.12, 0.78], P = 0.01), while complications and readmissions were comparable. Interestingly, there was no difference in operative time between the two surgical modalities, but subgroup analysis found that the retroperitoneal route robotic technique took longer (WMD = 14.64, 95% CI [0.04, 29.24], P < 0.05), whereas the study of the mixed surgical modality (RA versus LA with mixed transabdominal and retroperitoneal surgical routes) found that the robot required less time (WMD = -12.29, 95% CI [-22.86, -1.72], P < 0.05). For pheochromocytoma, RA was superior to LA in terms of length of stay (WMD = -0.49, 95% CI [-0.83, -0.15], P < 0.01), with no difference in other indicators. CONCLUSION robotic-assisted adrenalectomy is a superior technique to conventional laparoscopy in managing adrenal tumors, even in the case of a specific adrenal tumor - pheochromocytoma.
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12
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Nishikimi T, Mizuno H, Kashima A, Morikami H, Ishiguro S, Ohashi T, Yamada H. A case of robot‐assisted adrenalectomy performed for an adrenal tumor (anastomosing hemangioma) exceeding 7 cm. IJU Case Rep 2022; 5:469-473. [PMID: 36341203 PMCID: PMC9626352 DOI: 10.1002/iju5.12517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/24/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Anastomosing hemangioma in the adrenal area is extremely rare. We report a large anastomosing hemangioma in the adrenal area that underwent robot‐assisted adrenalectomy. Case presentation A 49‐year‐old man with left back pain underwent magnetic resonance imaging (MRI) that revealed a tumor in the left adrenal area; it was diagnosed as nonfunctional endocrinologically. However, the major axis of the tumor increased from 64 to 72 mm during the 4‐month period. Robot‐assisted left adrenalectomy was performed. Although the large tumor adhered to the surrounding tissues, it was safely resected by the effective use of an extra robotic arm. An anastomosing hemangioma was diagnosed since there were no malignant findings. Conclusion Robotic surgical systems may serve as an effective treatment option for large adrenal tumors, and our report is the first robot‐assisted adrenalectomy performed on an anastomosing hemangioma.
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Affiliation(s)
- Toshinori Nishikimi
- Department of UrologyJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalJapan
| | - Hideki Mizuno
- Department of UrologyJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalJapan
| | - Ayano Kashima
- Department of UrologyJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalJapan
| | - Hiroko Morikami
- Department of UrologyJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalJapan
| | - Shigeki Ishiguro
- Department of UrologyJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalJapan
| | - Tomoyoshi Ohashi
- Department of UrologyJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalJapan
| | - Hiroshi Yamada
- Department of UrologyJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalJapan
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13
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Law CY, Tang CN. Robotic Lateral Trans-Abdominal Adrenalectomy: Current Status. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00320-1] [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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14
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Champion NT, Monasterio D, Mukherjee I, Picon A. Robotic-assisted left adrenal cystic mass excision in a pregnant patient. BMJ Case Rep 2022; 15:e245954. [PMID: 35649621 PMCID: PMC9161104 DOI: 10.1136/bcr-2021-245954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2022] [Indexed: 11/04/2022] Open
Abstract
A symptomatic adrenal mass diagnosed during pregnancy is a rare clinical scenario. Two primary considerations are the timing of intervention and determining the appropriate surgical approach. Here, we present the case of a young female patient with flank pain, whom on diagnostic imaging, was found to have a large cystic adrenal mass. She was taken for a robotic-assisted resection of her left-sided adrenal mass during the second trimester of pregnancy. Preoperative and postoperative assessment demonstrated a viable intrauterine pregnancy. She tolerated the procedure well and was discharged 5 days later with resolution of her symptoms on follow-up. As one of only three reported cases of robotic adrenal surgery during pregnancy, we demonstrate that a robotic-assisted surgical approach is a viable and durable surgical option under the given clinical circumstances.
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Affiliation(s)
| | - Diego Monasterio
- Surgery, Staten Island University Hospital, Staten Island, New York, USA
| | | | - Antonio Picon
- Surgery, Stamford Health Medical Group, Stamford, Connecticut, USA
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15
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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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16
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Iglesias TG, Affeld MF, Zuniga A, Olmos R, Baudrand RF, San Francisco IF. Synchronous bilateral laparoscopic adrenalectomy: Surgical technique and perioperative results of a 13-years' experience. Actas Urol Esp 2022; 46:245-251. [PMID: 35260373 DOI: 10.1016/j.acuroe.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 04/21/2021] [Accepted: 05/02/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES Laparoscopic surgery is the standard approach for the treatment of adrenal glands. Bilateral synchronous adrenalectomy is rarely performed, and evidence about this procedure is limited. Our objective is to report our 13-year experience with synchronous laparoscopic bilateral adrenalectomy, evaluating its feasibility, safety, and perioperative outcomes. PATIENTS AND METHODS A total of 23 consecutive patients undergoing synchronous bilateral laparoscopic adrenalectomy between 2007 and 2020 in a single academic center were included. Variables evaluated were operative time, estimated blood loss, conversion to open surgery, postoperative complications, mortality, and postoperative length of stay. RESULTS Mean operative time was 189.3 ± 48.9 min. Mean estimated blood loss was 163.0 ± 201.3 mL. There were no conversions to open surgery. Five patients had postoperative complications, three of those were major. No patient died in the perioperative period. Median postoperative length of stay was three days (range 1-30). At pathology analysis, 15 patients had bilateral adrenal hyperplasia, 2 unilateral adrenal hyperplasia and a contralateral benign tumor, 1 unilateral adrenal hyperplasia and a normal contralateral gland, 1 unilateral adenoma, 3 bilateral pheochromocytomas and 1 bilateral myelolipoma. CONCLUSION Synchronous bilateral laparoscopic adrenalectomy is a feasible and safe technique. A multidisciplinary and experienced team involving anesthesiologists and endocrinologists is required.
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Affiliation(s)
- T G Iglesias
- Departamento de Urología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M F Affeld
- Departamento de Urología, Hospital Intercultural de Nueva Imperial, Nueva Imperial, Chile
| | - A Zuniga
- Departamento de Urología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Program of Adrenal Diseases, CETREN UC, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R Olmos
- Program of Adrenal Diseases, CETREN UC, Pontificia Universidad Católica de Chile, Santiago, Chile; Departamento of Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R F Baudrand
- Program of Adrenal Diseases, CETREN UC, Pontificia Universidad Católica de Chile, Santiago, Chile; Departamento of Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - I F San Francisco
- Departamento de Urología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Program of Adrenal Diseases, CETREN UC, Pontificia Universidad Católica de Chile, Santiago, Chile.
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17
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Al-Thani H, Al-Thani N, Al-Sulaiti M, Tabeb A, Asim M, El-Menyar A. A Descriptive Comparative Analysis of the Surgical Management of Adrenal Tumors: The Open, Robotic, and Laparoscopic Approaches. Front Surg 2022; 9:848565. [PMID: 35310427 PMCID: PMC8927071 DOI: 10.3389/fsurg.2022.848565] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/27/2022] [Indexed: 02/03/2023] Open
Abstract
BackgroundCurrently, adrenalectomies are trending toward minimally invasive approach including robotic and laparoscopic surgery. We aimed to describe the clinical presentation and outcomes associated with the 3 different surgical approaches in patients who underwent adrenalectomy for adrenal mass at a single tertiary center.MethodsA retrospective descriptive observational study was conducted to include all patients who underwent surgical interventions for adrenal gland mass between 2004 and 2019. Patients were categorized into three groups according to the interventional approach (open, robotic vs. laparoscopic adrenalectomy) and data were analyzed and compared.ResultsA total of 124 patients underwent adrenalectomies (61.3% robotic, 22.6% open, and 16.1% laparoscopic approach). Incidentally discovered adrenal mass was reported in 67% of patients, and hypertension was the most prevalent comorbidity (53%). The tendency for malignancy increased with increasing tumor size while the functioning tumors were more in the smaller tumor size. Larger tumors were more common in younger patients. The robotic approach showed shorter surgical intensive care and hospital length of stay. Patients in the open adrenalectomy group frequently presented with abdominal pain (p = 0.001), had more nonfunctional adrenal mass (p = 0.04), larger mean tumor size (p = 0.001), and were frequently operated on the right side (p = 0.03). There was no post-operative mortality; however, during follow-up, 8 patients died (3 open, 3 laparoscopic and, 2 robotic approach). The median follow-up was 746 days (range 7–5,840).ConclusionsThe study explored the three surgical adrenalectomy approaches in a dedicated center for patients with adrenal pathology. It showed that robotic adrenalectomy could be safe and effective surgical approach for patients with benign functioning adrenal tumors of a diameter <6 cm. However, the choice of a surgical approach varies according to the adrenal mass presentation, patient fitness for surgery, type and sizes of the tumor, surgeon's experience, and hospital resources. Open surgery is considered the first choice for larger, ruptured adrenal tumor or malignancy. However, the recent restructuring of the surgical department resulted in selection bias in favor of the robotic surgery. Further studies are required to address the risk factors, selection criteria for appropriate management, cost, and quality of life.
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Affiliation(s)
| | - Noora Al-Thani
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | | | | | - Mohammad Asim
- Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
- *Correspondence: Ayman El-Menyar
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18
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Differentiation between heterogeneous adrenal adenoma and non-adenoma adrenal lesion with CT and MRI. Abdom Radiol (NY) 2022; 47:1098-1111. [PMID: 35037990 DOI: 10.1007/s00261-022-03409-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/02/2022] [Accepted: 01/05/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE To assess whether heterogeneous adrenal adenomas can be distinguished from heterogeneous non-adenomas with Computed Tomography (CT) and/or Magnetic Resonance Imaging (MRI). METHOD From 2009 to 2019, 980 consecutive adrenalectomies were retrospectively identified. Patients without adequate CT/MRI, with homogeneous and/or < 1 cm lesions were excluded. Differences between adenomas and non-adenomas were analyzed using Chi-square, Student t or Fischer tests, and interobserver agreement using weighted kappa test or intraclass correlation coefficient. Independent variables associated with adenomas were searched for using multivariable analysis. Area under the receiver operating characteristic curve (AUC) of the final model and its diagnostic performances were calculated. RESULTS Final population comprised 183 patients (106 women, 77 men, mean age 53.2 ± 14.4 years) with 124 non-adenomas and 59 heterogeneous adenomas. Macroscopic or microscopic fat on CT/MRI allowed diagnosis of adenoma with 98% specificity and 63% sensitivity. Interobserver agreement was almost perfect for macroscopic fat (k = 0.82; 95% CI 0.66; 0.94) and substantial for microscopic fat (k = 0.75; 95% CI 0.62; 0.86). A multivariable model including micro- or macroscopic fat [Odds ratio (OR) 81.19; 95% CI 20.17; 572.27], diameter < 5.5 cm (OR 7.32; 95% CI 2.17; 31.28), calcifications (OR 5.68; 95% CI 2.08; 16.18), and hemorrhage (OR 3.10; 95% CI 0.70; 15.35) had an AUC of 0.91 (95% CI 0.86; 0.96), 71% (42/59, 95% CI 58; 82) sensitivity, 93% (115/124; 95% CI 87; 97) specificity, and 86% (157/183; 95% CI 79; 90) accuracy for the diagnosis of adenoma. CONCLUSION A multivariable model enables CT/MR diagnosis of heterogeneous adenomas. Presence of microscopic fat, even if partial, in a heterogeneous mass is highly specific of adenoma.
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19
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Alberici L, Ingaldi C, Ricci C, Selva S, Di Dalmazi G, Vicennati V, Pagotto U, Casadei R, Minni F. Minimally invasive adrenalectomy: a comprehensive systematic review and network meta-analysis of phase II/III randomized clinical controlled trials. Langenbecks Arch Surg 2022; 407:285-296. [PMID: 35022834 PMCID: PMC8847275 DOI: 10.1007/s00423-022-02431-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/02/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE The best approach for minimally invasive adrenalectomy is still under debate. METHODS A systematic search of randomized clinical trials was carried out. A frequentist random-effects network meta-analysis was made reporting the surface under the cumulative ranking (SUCRA). The primary endpoint regarded both in-hospital mortality and morbidity. The secondary endpoints were operative time (OP), blood loss (BL), length of stay (LOS), conversion, incisional hernia, and disease recurrence rate. RESULTS Eight studies were included, involving 359 patients clustered as follows: 175 (48.7%) in the TPLA arm; 55 (15.3%) in the RPLA arm; 10 (2.8%) in the Ro-TPLA arm; 25 (7%) in the TPAA arm; 20 (5.6%) in the SILS-LA arm; and 74 (20.6%) in the RPA arm. The RPLA had the highest probability of being the safest approach (SUCRA 69.6%), followed by RPA (SUCRA 63.0%). TPAA, Ro-TPLA, SILS-LA, and TPLA have similar probability of being safe (SUCRA values 45.2%, 43.4%, 43.0%, and 38.5%, respectively). Analysis of the secondary endpoints confirmed the superiority of RPA regarding OP, BL, LOS, and incisional hernia rate. CONCLUSIONS The best choice for patients with adrenal masses candidate for minimally invasive surgery seems to be RPA. An alternative could be RPLA. The remaining approaches could have some specific advantages but do not represent the first minimally invasive choice.
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Affiliation(s)
- Laura Alberici
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
| | - Carlo Ingaldi
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Claudio Ricci
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia.
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
- Dipartimento Di Scienze Mediche E Chirurgiche (DIMEC), Chirurgia Generale-Minni, Alma Mater Studiorum-Università Di Bologna, IRCCS, Policlinico S.Orsola-Malpighi, Via Massarenti n.9 40138, Bologna, Italy.
| | - Saverio Selva
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
| | - Guido Di Dalmazi
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
- Unit of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
| | - Valentina Vicennati
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
- Unit of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
| | - Uberto Pagotto
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
- Unit of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
| | - Riccardo Casadei
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesco Minni
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
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Vatansever S, Nordenström E, Raffaelli M, Brunaud L, Makay Ö. Robot-assisted versus conventional laparoscopic adrenalectomy: Results from the EUROCRINE Surgical Registry. Surgery 2022; 171:1224-1230. [PMID: 35027208 DOI: 10.1016/j.surg.2021.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 11/01/2021] [Accepted: 12/08/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Adrenalectomy is routinely performed via the minimally invasive approach. Safety of adrenalectomy using the robot-assisted technique has been widely demonstrated by several series, but the literature is scarce regarding the comparison of conventional laparoscopic versus robot-assisted approach. We decided to carry out a multicenter study to compare clinical and surgical outcomes between laparoscopic and robotic adrenalectomy. METHODS This is a retrospective case-control study, including data from centers affiliated to the Surgical Registry EUROCRINE. Patients undergoing laparoscopic surgery for adrenal tumors and registered between 2015 and 2018 were included. Robot-assisted versus laparoscopic adrenalectomy was compared. All comparisons were carried out in terms of complication rate, conversion rate and duration of stay. RESULTS A total of 1,005 patients from 46 clinics underwent robotic or conventional laparoscopic adrenalectomy. Median age was 55 (interquartile range: 45-65) years. Robotic adrenalectomy was performed in 189 (18.8%) patients. According to Clavien-Dindo classification, complication rate was lower in the robotic surgery group (1.6% vs 16.5%, P < .001). Laparoscopic surgery and active hormonal status were significantly correlated with complications, both in univariate and multivariate analysis. There was no significant difference between laparoscopic and robotic surgery groups, in terms of conversion rate (2.1% vs 0.5%, respectively, P = .147). Duration of stay was shorter in the robotic adrenalectomy group (82.1% vs 28.8%, P < .001). CONCLUSION Analysis of the EUROCRINE database supports that robotic adrenalectomy resulted in a lower complication rate and shorter duration of stay, compared with laparoscopic adrenalectomy. Granular data to support this is warranted.
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Affiliation(s)
- Safa Vatansever
- Department of General Surgery, Division of Endocrine Surgery, Ege University Hospital, Izmir, Turkey
| | - Erik Nordenström
- Department of Surgery, Division of Endocrine and Sarcoma Surgery, Lund University, Lund, Sweden
| | - Marco Raffaelli
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laurent Brunaud
- Université de Lorraine, Département de Chirurgie Viscérale, Métabolique et Cancérologique (CVMC), CHRU Nancy, Hopital de Brabois, Vandoeuvre-les-Nancy, France
| | - Özer Makay
- Department of General Surgery, Division of Endocrine Surgery, Ege University Hospital, Izmir, Turkey.
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21
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Francis A, Mellert L, Parekh N, Pozsgay M, Dan A. Robotic Adrenalectomy: A 10-Year Clinical Experience at a Tertiary Medical Center. JSLS 2022; 26:JSLS.2021.00083. [PMID: 35444401 PMCID: PMC8993463 DOI: 10.4293/jsls.2021.00083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objective: Laparoscopic adrenalectomy is now the preferred approach for most adrenal tumors. As minimally invasive surgery departments gain familiarity with the robotic platform, the safety profiles and efficacy of robotic adrenalectomy has been an area of continued discussion. The objective of this study is to outline our experience with transitioning to the robotic platform and determining the effectiveness and safety of transperitoneal robotic adrenalectomy. Methods: We performed a single-center, retrospective review of 37 patients who underwent transperitoneal robotic adrenalectomy between August 1, 2010 and August 31, 2020. Outcomes included patient morbidity, hospital length of stay, operative time, estimated blood loss, gland volume, pathology, and postoperative complications. Results: Sixty-five percent of the total robotic adrenalectomies were of the left adrenal gland. The average operating room time was 213 minutes. The average gland volume was 71 cm3, estimated blood loss was 74 mL and length of stay was 1.4 days. There were no significant differences in outcomes between the right and left total robotic adrenalectomies. Approximately one-third of our cohort had an adrenal cortical adenoma, while only one patient had adrenal cortical carcinoma. Four patients experienced postoperative complications that resulted in unplanned hospital readmissions and there was one mortality. Conclusions: Although the standard of care for most adrenal tumors is laparoscopic resection, our 10-year experience has shown that robotic adrenalectomy is highly effective and can be a valuable tool in the community and academic setting.
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Affiliation(s)
- Andrew Francis
- Department of General Surgery. Summa Health - Akron City Hospital, Akron, OH
| | - Logan Mellert
- Department of General Surgery. Summa Health - Akron City Hospital, Akron, OH
| | - Neel Parekh
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Mark Pozsgay
- Department of General Surgery. Summa Health - Akron City Hospital, Akron, OH
| | - Adrian Dan
- Department of General Surgery. Summa Health - Akron City Hospital, Akron, OH
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22
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Adrenalectomía laparoscópica bilateral sincrónica: técnica quirúrgica y resultados perioperatorios en 13 años de experiencia. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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23
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Xia Z, Li J, Peng L, Yang X, Xu Y, Li X, Li Y, Zhang Z, Wu J. Comparison of Perioperative Outcomes of Robotic-Assisted vs Laparoscopic Adrenalectomy for Pheochromocytoma: A Meta-Analysis. Front Oncol 2021; 11:724287. [PMID: 34604062 PMCID: PMC8481927 DOI: 10.3389/fonc.2021.724287] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/03/2021] [Indexed: 02/05/2023] Open
Abstract
Objective To compare the efficacy and safety of robotic-assisted adrenalectomy (RA) and standard laparoscopic adrenalectomy (LA) for pheochromocytoma (PHEO). Methods We systematically searched the Cochrane Library, PubMed, Embase, and Science databases for studies published through January 2021. Controlled trials on RA and LA for PHEOs were included. The meta-analysis was conducted with the Review Manager 5.4 software. Results Four studies with 386 patients were included in the analysis. There were no significant differences in OT (WMD: 0.16; 95% CI: -28.50 to 28.82; I2 = 89%; P = 0.99), transfusion rate (OR: 0.70; 95% CI: 0.07 to 7.07; I2 = 64%; P = 0.77), conversion rate (OR: 0.44; 95% CI: 0.07 to 2.88; I2 = 0%; P = 0.39), complication rate (OR: 1.06; 95% CI: 0.62 to 1.82; I2 = 0%; P = 0.84) among patients undergoing RA and LA. However, compared with patients who underwent LA, patients who underwent RA had a shorter LOS (OR: -0.50; 95% CI: -0.55 to 0.45; I2 = 31%; P<0.01), less EBL (WMD: -0.85; 95% CI: -13.56 to -2.54; I2 = 44%; P<0.01), and fewer IHD (OR: 0.34; 95% CI: 0.17 to 0.70; I2 = 0%; P<0.01). Conclusion The RA for pheochromocytoma achieve better outcomes over LA in terms of safety and efficacy.
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Affiliation(s)
- Zhongyou Xia
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Jinze Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Lei Peng
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Xiaoying Yang
- Blood Purification Center of Department of Nephrology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College, Nanchong, China
| | - Yulai Xu
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Xianhui Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Yunxiang Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Zongping Zhang
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Ji Wu
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
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Chen J, Wu J, Zhu R, Lu L, Ma XJ. Ablation versus laparoscopic adrenalectomy for the treatment of aldosterone‑producing adenoma: a meta-analysis. Abdom Radiol (NY) 2021; 46:2795-2804. [PMID: 33386911 DOI: 10.1007/s00261-020-02887-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the relative clinical efficacy and safety of ablation and laparoscopic adrenalectomy (LA) for the treatment of adrenal aldosterone-producing adenoma (APA). MATERIALS AND METHODS Pubmed, Embase, and Cochrane Library databases were searched for relevant studies, while the meta-analysis was performed with RevMan v5.3. RESULTS After initially identifying 496 potentially relevant studies, five were ultimately included in the final meta-analysis. In total, these studies contained 128 patients that underwent LA and 91 patients that underwent ablation to treat APA. Clinical success rates were comparable between these two groups (OR: 0.55, P = 0.20), whereas the pooled decreases of systolic and diastolic blood pressure were significantly larger in the ablation group (P = 0.01 and 0.002, respectively). Pooled changes in the aldosterone-to-renin ratio (ARR), serum potassium levels, and medication use were similar in both groups (P = 0.62, 0.24, and 0.96, respectively). The average operative duration in the ablation group was somewhat shorter, but the difference was not significant (MD: - 57.99; P = 0.05), whereas the average blood loss and postoperative hospital stay duration of patients in the ablation group were decreased for patients in the ablation group compared to the LA group (P < 0.00001 and 0.00001, respectively). Major complication, minor complication, and hypertension crisis rates were comparable between these groups (P = 0.35, 0.69, and 0.09, respectively). CONCLUSIONS Ablation offers comparable efficacy to LA when treating patients with APA, but is associated with a reduced operative duration, decreased intraoperative blood loss, and faster postoperative recovery.
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Affiliation(s)
- Jin Chen
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, China
| | - Juan Wu
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, China
| | - Rui Zhu
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, China
| | - Lu Lu
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, China.
| | - Xi-Juan Ma
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, 221000, China.
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25
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Prakobpon T, Santi-Ngamkun A, Usawachintachit M, Ratchanon S, Sowanthip D, Panumatrassamee K. Laparoscopic transperitoneal adrenalectomy in the large adrenal tumor from single center experience. BMC Surg 2021; 21:68. [PMID: 33522915 PMCID: PMC7849150 DOI: 10.1186/s12893-021-01080-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background The role of laparoscopic adrenalectomy (LA) in a large adrenal tumor is controversial due to the risk of malignancy and technical difficulty. In this study, we compared the perioperative outcomes and complications of LA on large (≥ 6 cm) and (< 6 cm) adrenal tumors. Methods We retrospectively reviewed all clinical data of patients who underwent unilateral transperitoneal LA in our institution between April 2000 and June 2019. Patients were classified by tumor size into 2 groups. Patients in group 1 had tumor size < 6 cm (n = 408) and patient in group 2 had tumor size ≥ 6 cm (n = 48). Demographic data, perioperative outcomes, complications, and pathologic reports were compared between groups. Results Patients in group 2 were significant older (p = 0.04), thinner (p = 0.001) and had lower incident of hypertension (p = 0.001), with a significantly higher median operative time (75 vs 120 min), estimated blood loss (20 vs 100 ml), transfusion rate (0 vs 20.8%), conversion rate (0.25 vs 14.6%) and length of postoperative stays ( 4 vs 5.5 days) than in group 2 (all p < 0.001). Group 2 patients also had significantly higher frequency of intraoperative complication (4.7 vs 31.3%; adjust Odds Ratio [OR] = 9.67 (95% CI 4.22–22.17), p-value < 0.001) and postoperative complication (5.4 vs 31.3%; adjust OR = 5.67 (95% CI 2.48–12.97), p-value < 0.001). Only eight (1.8%) major complications occurred in this study. The most common pathology in group 2 patient was pheochromocytoma and metastasis. Conclusions Laparoscopic transperitoneal adrenalectomy in large adrenal tumor ≥ 6 cm is feasible but associated with significantly worse intraoperative complications, postoperative complications, and recovery. However, most of the complications were minor and could be managed conservatively. Careful patient selection with the expert surgeon in adrenal surgery is the key factor for successful laparoscopic surgery in a large adrenal tumor. Trial registration: This study was retrospectively registered in the Thai Clinical Trials Registry on 02/03/2020. The registration number was TCTR20200312004.
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Affiliation(s)
- Thanasit Prakobpon
- Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
| | - Apirak Santi-Ngamkun
- Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
| | - Manint Usawachintachit
- Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
| | - Supoj Ratchanon
- Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
| | - Dutsadee Sowanthip
- Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
| | - Kamol Panumatrassamee
- Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand.
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26
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Piccoli M, Pecchini F, Serra F, Nigro C, Colli G, Gozzo D, Zirilli L, Madeo B, Rochira V, Mullineris B. Robotic Versus Laparoscopic Adrenalectomy: Pluriannual Experience in a High-Volume Center Evaluating Indications and Results. J Laparoendosc Adv Surg Tech A 2021; 31:375-381. [PMID: 33450160 PMCID: PMC8060876 DOI: 10.1089/lap.2020.0839] [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] [Indexed: 02/06/2023] Open
Abstract
Background: Robotic adrenalectomy offers several clinical benefits if compared with laparoscopic adrenalectomy; however, its superiority is still under debate. The aim of this study was the investigation of differences between the two techniques, and a comparison when approaching right or left side adrenal lesions was further conducted. Materials and Methods: All patients undergoing laparoscopic and robotic unilateral adrenalectomy at our institution from January 2006 to December 2019 were collected and retrospectively analyzed. Statistical analysis was conducted; differences between the two cohorts were reported. Results: A total of 160 cases were included (84 patients in laparoscopic adrenalectomy-group [LA-g] 76 cases in robotic adrenalectomy-group [RA-g]). The groups were homogeneous for demographic data. No intraoperative complications were reported; mean amount of intraoperative blood loss was comparable. No cases of conversion to open surgery were required. RA-g presented a longer operative time than LA-g for right adrenalectomy (P = .05), no differences were noted for left side (P = .187). Overall morbidity was 21% for LA-g and 10.5% for RA-g (P = .087), with an inferior rate of surgical complications for RA-g (P = .024), and for robotic left adrenalectomy than robotic right procedure (P = .03). Length of hospital stay was shorter for RA-g (P = .005). Conclusions: Robotic adrenalectomy presents similar outcomes as laparoscopic approach with some benefits for selected cases. Left adrenal lesions seem to receive greater advantages from robotic technique. Large randomized controlled trials are required to determine the role of robotic adrenal surgery and if the indication can be standardized based on the laterality of adrenal procedure.
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Affiliation(s)
- Micaela Piccoli
- Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital, Modena, Italy
| | - Francesca Pecchini
- Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital, Modena, Italy
| | - Francesco Serra
- Department of Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Casimiro Nigro
- General Surgery Department, Torvergata University, Rome, Italy
| | - Giovanni Colli
- Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital, Modena, Italy
| | - Davide Gozzo
- Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital, Modena, Italy
| | - Lucia Zirilli
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Bruno Madeo
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Mullineris
- Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital, Modena, Italy
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27
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Fuschi A, Al Salhi Y, Velotti G, Capone L, Martoccia A, Suraci PP, Scalzo S, Annino F, Khorrami S, Asimakopoulos A, Bozzini G, Falsaperla M, Carbone A, Pastore AL. Holmium laser enucleation of prostate versus minimally invasive simple prostatectomy for large volume (≥120 mL) prostate glands: a prospective multicenter randomized study. Minerva Urol Nephrol 2020; 73:638-648. [PMID: 33200899 DOI: 10.23736/s2724-6051.20.04043-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this study was to compare the perioperative and functional results between laparoscopic and robot-assisted simple prostatectomy (LSP and RASP) and Holmium laser enucleation of prostate (HoLEP) in prostate volumes ≥120 mL. The primary endpoint was to investigate and compare minimally invasive techniques in the management of large prostate gland volume, and the secondary endpoint was to evaluate the frequency and type of postoperative complications according to Clavien Dindo Classification. METHODS This multicenter study was conducted on male patients with LUTS associated with BPO candidates for surgical treatment. The surgery approach choice in relation to the prostatic volume ≥120 mL was HoLEP or minimally-invasive simple prostatectomy (LSP or RASP). All patients were prospectively randomized into three groups, according to a simple computed randomization: HoLEP, LSP and RASP groups. During the follow-up, all patients underwent postoperative control at 1, 3, 6, 12 and 24 months from the surgical procedure. RESULTS One hundred ten male patients were randomized in three homogeneous groups: 36 in LSP, 32 in RASP and 42 in HoLEP group. During the follow-up (mean 26.15 months), despite the significant improvement compared to baseline results, no significant differences were shown, between the groups in terms of functional and perioperative outcomes. The only statistically significant data was reported for catheterization time, that resulted longer in the LSP group than RASP and HoLEP groups (P=0.002). Furthermore, MISP resulted in longer hospitalization, and lower rate of patients with new-onset irritative symptoms. CONCLUSIONS This prospective randomized study is the first to compare extraperitoneal LSP, RASP and HoLEP in the treatment of LUTS secondary to benign prostatic hyperplasia for prostate volumes ≥120 mL. Our findings confirm the safety and efficacy of MISP, demonstrating its equivalence in functional outcomes and perioperative morbidity in comparison to HoLEP.
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Affiliation(s)
- Andrea Fuschi
- Unit of Urology, Department of Medical, Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University, Latina, Italy.,ICOT - Surgery, Orthopedy, Traumatology Institute, Latina, Italy
| | - Yazan Al Salhi
- Unit of Urology, Department of Medical, Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University, Latina, Italy.,ICOT - Surgery, Orthopedy, Traumatology Institute, Latina, Italy
| | - Gennaro Velotti
- Unit of Urology, Department of Medical, Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University, Latina, Italy
| | - Lorenzo Capone
- Unit of Urology, Department of Medical, Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University, Latina, Italy
| | - Alessia Martoccia
- Unit of Urology, Department of Medical, Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University, Latina, Italy
| | - Paolo P Suraci
- Unit of Urology, Department of Medical, Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University, Latina, Italy
| | - Silvio Scalzo
- Unit of Urology, Department of Medical, Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University, Latina, Italy
| | | | | | | | - Giorgio Bozzini
- Unit of Urology, Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | | | - Antonio Carbone
- Unit of Urology, Department of Medical, Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University, Latina, Italy.,Uroresearch, Non-Profit Urology Research Association, Latina, Italy
| | - Antonio L Pastore
- Unit of Urology, Department of Medical, Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University, Latina, Italy - .,Uroresearch, Non-Profit Urology Research Association, Latina, Italy
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Gokceimam M, Akbulut S, Erten O, Kahramangil B, Kim YS, Li P, Berber E. An intra-operative video comparison of laparoscopic versus robotic transabdominal lateral adrenalectomy. Int J Med Robot 2020; 17:e2203. [PMID: 33185308 DOI: 10.1002/rcs.2203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/20/2020] [Accepted: 11/12/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND The aim was to compare intraoperative conduct of adrenalectomy between laparoscopic and robotic approaches. METHODS Intraoperative video-recordings of patients who underwent robotic (n = 30) and laparoscopic adrenalectomy (n = 30) were analysed using Mann-Whitney U, chi-square and multivariate regression analyses. RESULTS Demographics, indications and outcomes were similar between groups. For all tumour sizes, camera was more engaged to surgical task and exhibited less vision problems in robotic versus laparoscopic group. There was less instrument exchange and restriction of exposure with robotic approach. For dissection, robotic approach allowed for a wider range of instrument reach around adrenal. Robotically, there was an increased ability to do fine dissection, rather than en bloc division with rigid laparoscopic vessel sealers. Bleeding problems were less robotically. CONCLUSION Despite similarities in post-operative morbidity and hospital stay, there was a superiority in quality of procedure performed with robotic versus laparoscopic adrenalectomy for both small and large adrenal tumours.
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Affiliation(s)
- Mehmet Gokceimam
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Serkan Akbulut
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ozgun Erten
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bora Kahramangil
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Yoo S Kim
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pengpeng Li
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio, USA.,Department General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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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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30
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Alahmed F, Nomine-Criqui C, Poirier A, Demarquet L, Brunaud L, Aljehani A. Robotic Adrenalectomy: Updates on Lateral Transperitoneal Approach. CURRENT SURGERY REPORTS 2020. [DOI: 10.1007/s40137-020-00276-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Robotic adrenalectomy in the pediatric population: initial experience case series from a tertiary center. BMC Urol 2020; 20:155. [PMID: 33028284 PMCID: PMC7542890 DOI: 10.1186/s12894-020-00727-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 09/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Laparoscopic resection is the most well described minimally-invasive approach for adrenalectomy. While it allows for improved cosmesis, faster recovery and decreased length of hospital stay compared with the open approach, instrument articulation limitations can hamper surgical dexterity in pediatric patients. Use of robotic assistance can greatly enhance operative field visualization and instrument control, and is in the early stages of adoption in academic centers for pediatric populations. CASE PRESENTATION We present a single-institution series of pediatric adrenalectomy cases. The da Vinci Xi surgical system was used to perform adrenalectomies on three consecutive patients (ages, 2-13 years) at our center. Final pathology revealed ganglioneuroblastoma (n = 2) and pheochromocytoma (n = 1). Median operating time was 244 min (range, 244-265 min); median blood loss was estimated at 100 ml (range, 15-175 ml). Specimens were delivered intact and all margins were negative. Median post-operative hospital stay was 2 days (range, 1-6 days). All patients remain disease-free at median follow-up of 19 months (range, 12-30 months). CONCLUSION Our experience continues to evolve, and suggests that robotic surgery is safe, feasible and oncologically effective for resection of adrenal masses in well-selected pediatric patients.
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Ozdemir M, Dural AC, Sahbaz NA, Akarsu C, Uc C, Sertoz B, Alis H, Makay O. Robotic transperitoneal adrenalectomy from inception to ingenuity: the perspective on two high volume endocrine surgery centers. Gland Surg 2020; 9:815-825. [PMID: 32775274 DOI: 10.21037/gs.2020.02.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background With increased utilization of robotic technology, robotic adrenalectomy (RA) became popular in certain high-volume centers as an alternative to conventional laparoscopic adrenalectomy (LA). The aim of the present study was to evaluate clinical and surgical outcomes of RA in two high-volume centers in Turkey. Methods Between 2012 and 2019, consecutive patients who underwent robotic transperitoneal adrenalectomy in two referral centers for surgical endocrine diseases in Turkey were analyzed retrospectively. Results A total of 111 patients were analyzed. Mean diameter of the tumor in preoperative imaging was 38.6±2.0 mm. Total operation time was 135.4±47.9 min. The analysis of the learning curve period and the post-learning curve period in both centers demonstrated that the total surgery time decreased from 152.68±48.6 to 118.8±37.1 min, and the console time decreased from 113.2±38.9 to 81.6±35.1 min (P<0.0001). In 8 patients, complications arose during the surgery and postoperative complications were observed in 10 patients. Intraoperative complication rate was 28% in patients with a tumor diameter of greater than 50 mm (P<0.0001). There was no mortality. Conclusions Our study demonstrated that RA is a safe and effective procedure with low-morbidity and without mortality in high number of cases.
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Affiliation(s)
- Murat Ozdemir
- Division of Endocrine Surgery, Department of Surgery, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Ahmet Cem Dural
- Department of Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Faculty of Medicine, Istanbul, Turkey
| | - Nuri Alper Sahbaz
- Department of Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Faculty of Medicine, Istanbul, Turkey
| | - Cevher Akarsu
- Department of Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Faculty of Medicine, Istanbul, Turkey
| | - Can Uc
- Division of Endocrine Surgery, Department of Surgery, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Berk Sertoz
- Division of Endocrine Surgery, Department of Surgery, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Halil Alis
- Department of Surgery, VM Medical Park Hospital Florya, Istanbul Aydin University, Faculty of Medicine, Istanbul, Turkey
| | - Ozer Makay
- Division of Endocrine Surgery, Department of Surgery, Ege University, Faculty of Medicine, Izmir, Turkey
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Makay Ö. Introduction to series on robotic adrenalectomy. Gland Surg 2020; 9:812-814. [PMID: 32775273 DOI: 10.21037/gs-2019-ra-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Özer Makay
- Professor of Surgery, Division of Endocrine Surgery, Department of Surgery, Ege University Hospital, Izmir, Turkey
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34
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Comparison between retroperitoneal and transperitoneal laparoscopic adrenalectomy: Are both equally safe? J Visc Surg 2020; 158:204-210. [PMID: 32773296 DOI: 10.1016/j.jviscsurg.2020.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVES Compare the rates of major intra- and postoperative complications, surgical conversion and mortality between transperitoneal versus retroperitoneal laparoscopic adrenalectomy. PATIENTS AND METHODS In a series of 344 consecutive unilateral laparoscopic adrenalectomies, performed from January 1997 to December 2017, we evaluated the rates of major intra- and postoperative complications (Clavien-Dindo≥III) and surgical conversion of the two approaches. RESULTS The retroperitoneal laparoscopic route was used in 259 patients (67.3%) and the transperitoneal laparoscopic route in 85 patients (22.1%). A total of 12 (3.5%) major postoperative complications occurred, with no statistically significant difference between the two approaches (P=0.7). In univariate analysis, the only predictor of major postoperative complication was Cushing's syndrome (P=0.03). The surgical conversion rate was higher in the transperitoneal route group (10/85 (11.8%) compared to 6/259 (2.3%), P=0.0003) in the retroperitoneal route group. One death occurred in each group. Independent predictors of surgical conversion in multivariate analysis included the transperitoneal laparoscopic approach (OR 1.7, 95% CI 1.3-1.9, P=0.02), advanced age (OR 1.2, 95% CI 1.1-1.6, P=0.04) and large tumor size (OR 1.3, 95% CI 1.1-1.7, P=0.01). CONCLUSION Both transperitoneal and retroperitoneal approaches for laparoscopic adrenalectomy are safe, with an equivalent rate of major complications and mortality. The surgical conversion rate was higher for the transperitoneal route. The retroperitoneal approach should be reserved for small adrenal lesions.
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Moughnyeh M, Lindeman B, Porterfield JR, Dream S. Outpatient robot-assisted adrenalectomy: Is it safe? Am J Surg 2020; 220:296-297. [DOI: 10.1016/j.amjsurg.2020.04.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
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Minimally Invasive Partial Versus Total Adrenalectomy for the Treatment of Primary Aldosteronism: Results of a Multicenter Series According to the PASO Criteria. Eur Urol Focus 2020; 7:1418-1423. [PMID: 32660839 DOI: 10.1016/j.euf.2020.06.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/20/2020] [Accepted: 06/29/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Determination of success after adrenal-sparing surgery for primary aldosteronism (PA) is limited by the lack of standardized definitions of outcomes. OBJECTIVE To evaluate the safety and effectiveness of minimally invasive partial adrenalectomy (MIPA) for PA by comparing perioperative and functional outcomes with minimally invasive total adrenalectomy (MITA) according to the Primary Aldosteronism Surgical Outcome (PASO) criteria. DESIGN, SETTING, AND PARTICIPANTS Between March 2011 and April 2020, a multicenter adrenalectomy dataset was queried for "unilateral adrenal mass, PA, MIPA (n = 29), or MITA (n = 61)"at four participating Institutions. INTERVENTION MITA and MIPA for PA. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Differences between continuous variables were assessed with the Wilcoxon rank sum test, while Pearson's χ2 test was used for categorical data. Complete, partial, and absent clinical success rates were assessed for the overall cohort and compared between groups. RESULTS AND LIMITATIONS The median tumor size was significantly higher in the MITA group (4.2 vs 2.7 cm; p = 0.001), while preoperative hypertension rate was significantly higher in the MIPA series (82.8% vs 57.4%, p = 0.01). The median length of hospital stay was increased in the MITA cohort (4 vs 3 d; p = 0.038). Overall, at a median follow-up of 42 mo (interquartile range 27-54 mo), complete, partial, and absent clinical success was observed in 60%, 17.7%, and 22.3% of cases, respectively. The complete clinical success rate was higher in the MIPA group (72.4% vs 54.1%), while a partial clinical success was higher in the MITA series (23% vs 6.8%). The absence of clinical success was comparable between groups (MITA 23% vs MIPA 20.7%). CONCLUSIONS MIPA showed excellent perioperative results with a complete clinical success rate of 72.4%. Owing to the heterogeneity of the PASO criteria in the assessment of partial or absent success, the quest for a univocal definition of satisfactory clinical outcomes in the treatment of PA remains open. PATIENT SUMMARY We compared minimally invasive partial adrenalectomy (MIPA) and minimally invasive total adrenalectomy for the treatment of unilateral primary aldosteronism, assessing the outcomes with the Primary Aldosteronism Surgical Outcome (PASO) criteria. MIPA seems to provide comparable perioperative outcomes and midterm clinical success rates.
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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 2020; 8:89-99. [PMID: 33569275 PMCID: PMC7859360 DOI: 10.1016/j.ajur.2020.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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
Since its introduction more than 30 years ago, laparoscopic adrenalectomy has become the gold standard approach to adrenal surgery for the majority of adrenal pathology. It has been shown to have superior clinical benefits to open adrenalectomy for the majority of cases of adrenal surgery. Robot-assisted adrenalectomy has also been shown to be a reasonable alternative approach to adrenal gland resection. Even though robot-assisted adrenalectomy has been performed in the United States for more than 20 years, it has yet to become the gold-standard for this operation, evidenced by the fact that in the United States laparoscopic adrenalectomy remains more common than robot-assisted adrenalectomy. Market factors, clinical factors and surgeon factors all play a role in the spread and adoption of robotic surgery in general. Here we review the most up to date literature on the state of robotic adrenalectomy in the United States, and explore some of the factors that may be influencing the rate of adoption of robotic adrenalectomy in the United States.
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Affiliation(s)
- Raymon H Grogan
- Section Chief of Endocrine Surgery, Baylor St. Luke's Medical Center, Houston, TX, USA
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Inversini D, Manfredini L, Galli F, Zhang D, Dionigi G, Rausei S. Risk factors for complications after robotic adrenalectomy: a review. Gland Surg 2020; 9:826-830. [PMID: 32775275 DOI: 10.21037/gs.2020.04.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The application of adrenal surgery has been spreading steadily in recent years. With the increased use of robotics in surgery, robotic adrenalectomy (RA), especially for the posterior retroperitoneoscopic approach, has been taken on by many high-volume institutions as a good option over the standard laparoscopic approach (LA). This paper reviews the recent literature from May 2010 up to November 2019 with the aim of analyzing RA complications in order to identify risk factors for complications after RA. We analyzed 7 principal risk factors for complication: body mass index (BMI), age, tumor size, tumor side, pathology, previous surgery, and surgeon experience. In the review, some studies identified tumor size, malignancy type, completion of learning curve and, and less clearly, previous ipsilateral upper mesocolic or retroperitoneal surgery, as risk factors for postoperative complications and failure of robotic surgery. Whether RA is meaningfully superior to the standard minimally invasive approach is still a subject of discussion. RA appears safer by virtue of its reduction in hospital stay, lower blood loss, and equivalent complication rates, and surgeons should prefer adrenalectomy over the LA. Despite these advantages, the operative time and the overall cost of the robotic procedure are higher than the LA. Further high-quality trials, especially those analyzing the specific risk factors for complications in robotic surgery, should be conducted in order to optimize the stratification of patients eligible for robotic surgery.
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Affiliation(s)
- Davide Inversini
- Endocrine and Metabolic Surgery, University of Insubria, Varese, Italy
| | - Livia Manfredini
- Endocrine and Metabolic Surgery, University of Insubria, Varese, Italy
| | - Federica Galli
- Department of Surgery, ASST Valle Olona, Gallarate, Italy
| | - Dai Zhang
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, China-Japan Union Hospital of Jilin University, Changchun 130600, China
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Stefano Rausei
- Department of Surgery, ASST Valle Olona, Gallarate, Italy
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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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Cummings JJ, Siegrist KK, Deegan RJ, Solórzano CC, Eagle SS. Robotic Adrenalectomy for Pheochromocytoma in a Patient with Fontan Physiology. J Cardiothorac Vasc Anesth 2020; 34:2446-2451. [PMID: 32434722 DOI: 10.1053/j.jvca.2020.02.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Jared J Cummings
- Division of Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Kara K Siegrist
- Division of Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Robert J Deegan
- Division of Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Carmen C Solórzano
- Division of Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Susan S Eagle
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
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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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Robotically Assisted Omentum Flap Harvest: A Novel, Minimally Invasive Approach for Vascularized Lymph Node Transfer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2505. [PMID: 32440389 PMCID: PMC7209865 DOI: 10.1097/gox.0000000000002505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 01/11/2023]
Abstract
Background: The omentum provides abundant lymphatic tissue with reliable vascular anatomy, representing an ideal donor for vascularized lymph node transfer without risk for donor site lymphedema. We describe a novel, robotically assisted approach for omental flap harvest. Methods: All patients undergoing robotically assisted omentum harvest for vascularized lymph node transfer from 2017 to 2019 were identified. Patient demographics, intraoperative variables, and postoperative outcomes were reviewed. Results: Five patients underwent robotically assisted omentum flap harvest for vascularized lymph node transfer. The average patient age and body mass index were 51.2 years and 29.80 kg/m2, respectively. Indications for lymph node transfer were upper extremity lymphedema following mastectomy, radiation, and lymphadenectomy (60.0%); congenital unilateral lower extremity lymphedema (20.0%); and bilateral lower extremity/scrotal lymphedema following partial penectomy and bilateral inguinal/pelvic lymphadenectomy (20.0%). Four patients (80.0%) underwent standard robotic harvest, whereas 1 patient underwent single-port robotic harvest. The average number of port sites was 4.4. All patients underwent omentum flap transfer to 2 sites; in 2 cases, the flap was conjoined, and in 3 cases, the flap was segmented. The average overall operative time was 9:19. The average inpatient hospitalization was 5.2 days. Two patients experienced cellulitis, which is resolved with oral antibiotics. There were no major complications. All patients reported subjective improvement in swelling and softness of the affected extremity. The average follow-up was 8.8 months. Conclusions: Robotically assisted omental harvest for vascularized lymph node transfer is a novel, safe, and viable minimally invasive approach offering improved intra-abdominal visibility and maneuverability for flap dissection.
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Mazzaglia PJ, Varghese J, Habra MA. Evaluation and management of adrenal neoplasms: endocrinologist and endocrine surgeon perspectives. Abdom Radiol (NY) 2020; 45:1001-1010. [PMID: 32189021 DOI: 10.1007/s00261-020-02464-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The evaluation and management of adrenal disease is a complex endeavor that relies on an expert knowledge of human physiology and anatomy. Careful and proper patient assessment mandates a balanced approach which marries the disciplines of endocrinology, surgery, and radiology. Any of these three specialties may be on the front line in performing the initial workup when an adrenal neoplasm is discovered. With an ever-increasing volume of cross-sectional imaging, be it CT, MRI, or PET, large numbers of adrenal incidentalomas are being discovered. A close collaboration amongst specialties should strive to streamline the initial evaluation and minimize unnecessary testing and treatment.
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45
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Evolution of adrenal surgery in a tertiary referral centre. Ir J Med Sci 2020; 189:1305-1310. [PMID: 32140992 DOI: 10.1007/s11845-020-02204-8] [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] [Received: 11/07/2019] [Accepted: 02/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic transperitoneal and retroperitoneoscopic adrenalectomy have largely replaced open adrenal surgery, particularly in benign disease. Laparoscopic surgery results in less post-operative pain, fewer surgical site complications and reduced length of hospital stay. The aim of this retrospective study was to analyse the characteristics of patients and evolution of surgical technique in adrenal surgery at Cork University Hospital over a 12-year period. METHODS All cases of adrenalectomy between January 1st, 2007 and December 31st, 2018 were retrospectively reviewed. Patient demographics, diagnosis, surgical approach, length of hospital stay, histology and complications were evaluated. Comparisons were made between open, laparoscopic transperitoneal and retroperitoneoscopic adrenalectomy cases. RESULTS There were 57 adrenalectomies performed on 55 patients over the 12-year period. Twenty-six patients (46%) were male, and the mean age was 49 years (range 14-84 years). Twenty-two (39%) right-sided adrenalectomies were performed, 33 (57%) left sided and 2 (4%) patients underwent bilateral surgery. Seventeen adrenalectomies were performed using an open transperitoneal approach, 30 via a laparoscopic transperitoneal approach and 10 using the retroperitoneoscopic technique. Adenoma and pheochromocytoma were the most common indications for surgery (42% and 40%, respectively). Seven percent were performed for malignancy and 5% for other benign indications. The complication rate for open adrenalectomy was 18% versus 10% in laparoscopic transperitoneal adrenalectomy and 0% for retroperitoneoscopic adrenalectomy. Two patients (7%) undergoing laparoscopic transperitoneal surgery required conversion to an open procedure. There were no 30-day mortalities and no disease recurrence within the study time frame. The mean length of hospital stay was 7.6 days in the open group, 5.8 days for the laparoscopic transperitoneal group and 3 days for the retroperitoneoscopic group (p = 0.03). CONCLUSIONS Adrenalectomy is a safe procedure and in our setting was primarily performed for pheochromocytoma and non-functioning adenomas. Minimally invasive adrenalectomy has become the standard of care internationally and is associated with fewer complications, shorter hospital stay and a low conversion rate.
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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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Patel D, Phay JE, Yen TWF, Dickson PV, Wang TS, Garcia R, Yang AD, Kim LT, Solórzano CC. Update on Pheochromocytoma and Paraganglioma from the SSO Endocrine and Head and Neck Disease Site Working Group, Part 2 of 2: Perioperative Management and Outcomes of Pheochromocytoma and Paraganglioma. Ann Surg Oncol 2020; 27:1338-1347. [PMID: 32112213 DOI: 10.1245/s10434-020-08221-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Indexed: 01/10/2023]
Abstract
This is the second part of a two-part review on pheochromocytoma and paragangliomas (PPGLs). In this part, perioperative management, including preoperative preparation, intraoperative, and postoperative interventions are reviewed. Current data on outcomes following resection are presented, including outcomes after cortical-sparing adrenalectomy for bilateral adrenal disease. In addition, pathological features of malignancy, surveillance considerations, and the management of advanced disease are also discussed.
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Affiliation(s)
- Dhaval Patel
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - John E Phay
- Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Tina W F Yen
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Paxton V Dickson
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Tracy S Wang
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Roberto Garcia
- Division of Surgical Oncology, National Cancer Institute of Panama/Paitilla Medical Center, Panama City, Panama
| | - Anthony D Yang
- Division of Surgical Oncology, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lawrence T Kim
- Division of Surgical Oncology and Endocrine Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Carmen C Solórzano
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University, Nashville, TN, USA
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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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Barczyński M. Introduction to focused issue on novel technologies in endocrine surgery. Gland Surg 2020; 9:S65-S68. [PMID: 32175246 PMCID: PMC7044079 DOI: 10.21037/gs.2020.01.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marcin Barczyński
- Professor of Surgery, Department of Endocrine Surgery, Third Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
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Teaching in the robotic environment: Use of alternative approaches to guide operative instruction. Am J Surg 2020; 219:191-196. [DOI: 10.1016/j.amjsurg.2019.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 01/18/2023]
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