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Azhar RA, Buksh O, Almalki AM, Akram R, Alzahrani H, Al-Gadheeb A, Mandoorah Q, Alammari AA. Outcomes of Minimally Invasive Adrenalectomy for Large Adrenal Masses: A Multi-Centre Experience in Saudi Arabia. Cureus 2024; 16:e55276. [PMID: 38558592 PMCID: PMC10981574 DOI: 10.7759/cureus.55276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Advancements in radiological imaging technology have increased the discovery of adrenal incidentalomas. Large adrenal tumors (LATs) are not common, and the likelihood of malignancy increases with tumor size. LATs were defined as tumors larger than four centimeters (cm) with various pathologic diagnoses. Traditionally, open adrenalectomy was considered the gold standard for LATs, but with recent advancements in minimally invasive surgery (MIS), optimum perioperative and long-term outcomes are achievable by the MIS approach. The findings presented in this paper show that even large adrenal masses measuring up to 21 centimeters can be safely removed using a minimally invasive approach. Methodology After Institutional Review Board (IRB) approval, we reviewed medical records of adult patients who had adrenalectomies at two Saudi Arabian centers from January 2013 to February 2023. Inclusion criteria were laparoscopic or robotic adrenalectomy and adrenal lesions ≥5cm. Pediatric patients and those with open adrenalectomies were excluded. Pre-surgery, patients had imaging studies to assess mass characteristics. Pheochromocytoma patients received a 2-week adrenergic blocker treatment. Perioperative data including demographics, comorbidities, mass characteristics, surgery details, and follow-up were analyzed using SPSS-23. Patients provided informed consent and had follow-up appointments and imaging. Results Our experience involved 35 patients, 29 of whom received laparoscopic treatment and six of whom underwent robotic surgery. Of the 35 patients, more than half were females (57.1%), with a mean age of 41.7±14.9 years, the youngest and oldest participants being 16 and 73 years of age, respectively. The mean body mass index (BMI) of the participants was in the overweight range (26±6.0 kg/m2). The most common mode of presentation was incidental (42.9%), followed by hypertension (17.1%). Most patients had right-sided adrenal gland involvement (48.6%), with only four patients showing bilateral involvement. Most of the patients were classified as American Society of Anesthesiology score (ASA) 2 (40.0%) or ASA 3 (40.0%). Most of the patients were diagnosed with myelolipoma or adenoma (22.9% each) followed by pheochromocytoma (17.1%). The average estimated blood loss (EBL) was 189.3±354.6 ml for patients who underwent laparoscopic surgery and 80.0 ±34.6 ml for patients who underwent robotic surgery. The average operative room time (ORT) was 220.1±98.7 minutes (min) for laparoscopic surgery and 188.3±10.3 min for robotic surgery. One patient had to be converted from laparoscopic to open surgery due to aortic injury. The average length of stay (LOS) was 9.5±6.7 days for laparoscopic treatment and 5.5±1.9 days for robotic surgery. The mean tumor size in the greatest dimension was 8.0±4.4 cm. Only one patient who underwent unilateral laparoscopy experienced perioperative complications and converted to open surgery; nine patients who underwent unilateral laparoscopy required blood transfusion, and none of the patients who underwent robotic surgery required transfusion. None of the 35 patients experienced a recurrence of their adrenal disease during the mean follow-up period which lasted around 58 months. Conclusion MIS in Saudi Arabia is growing and is a safe method for LATs, with satisfactory surgical results compared to the traditional open surgery approach. It offers advantages in terms of EBL, complications, and disease recurrence.
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Affiliation(s)
- Raed A Azhar
- Urology Department, King Abdulaziz University, Faculty of Medicine, Jeddah, SAU
- Urology Department, International Medical Center, Jeddah, SAU
| | - Omar Buksh
- Urology Department, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Abdullah M Almalki
- Urology Department, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Rabea Akram
- Urology Department, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Hani Alzahrani
- Urology Department, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | | | - Qusay Mandoorah
- Urology Department, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Adel A Alammari
- Urology Department, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
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Dashti SAH, Kim WW, Lee YM, Song DE, Lee SH, Koh JM, Sung TY, Chung KW, Cho JW. Exploring the Benefits of a Reduced-Port Approach in Robotic Posterior Retroperitoneoscopic Adrenalectomy: A Comparative Study of the Two-Port and Three-Port Techniques. J Laparoendosc Adv Surg Tech A 2024; 34:147-154. [PMID: 38363816 DOI: 10.1089/lap.2023.0406] [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] [Indexed: 02/18/2024] Open
Abstract
Background: Robotic adrenalectomy has become a surgical treatment option for benign and selected malignant adrenal diseases. We aimed to evaluate the eligibility of two-port robotic posterior retroperitoneoscopic adrenalectomy (PRA) as an alternative to the conventional three-port technique by comparing their surgical outcomes. Materials and Methods: This retrospective cohort study compared the clinicopathological factors and surgical outcomes among 197 patients who underwent two-port or three-port robotic adrenalectomy between 2016 and 2020 in a single tertiary center. For further evaluation, propensity score matching was performed to reduce the selection bias in population characteristics. Results: Patients were categorized by the number of ports (two-port group, 87; and three-port group, 110). The two-port group compared with the three-port group was significantly older (P = .006) and had a smaller mean tumor size (P = .003) and shorter mean operation time (P = .001). Upon comparing clinicopathologic characteristics according to adrenal disorders, for pheochromocytoma, the three-port group had a larger tumor size and a longer operation time. For Cushing's syndrome, the operation time was short and numeric rating scale pain score was significantly low in the two-port group. After propensity score matching, the two-port group had a short operation time and a significantly low postoperative pain score (P < .05). Predictive factors associated with prolonged operation time included male gender, an increased number of ports, and large tumor size. Conclusions: The two-port technique resulted in a shorter operation time and lower pain score compared with the three-port technique. The two-port technique may be a safe alternative to the conventional three-port technique for robotic PRA.
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Affiliation(s)
| | - Won Woong Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yu-Mi Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Eun Song
- Department of Pathology, and Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Hun Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Min Koh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yon Sung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Wook Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Won Cho
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Shi H, Fu S, Wang J, Wang H. A commentary on '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]. Int J Surg 2023; 109:213-214. [PMID: 36799857 PMCID: PMC10389410 DOI: 10.1097/js9.0000000000000128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 02/18/2023]
Affiliation(s)
| | | | | | - Haifeng Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan, China
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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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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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Giant symptomatic adrenal myelolipoma: A case report. Ann Med Surg (Lond) 2022; 75:103333. [PMID: 35198182 PMCID: PMC8844840 DOI: 10.1016/j.amsu.2022.103333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 11/23/2022] Open
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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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Azhar RA, Rabah D, Alenizi AM, Alammari A, Alasker A, Alqahtani AA, Alsaikhan BH, Alyami FA, Alzahrani HM, Alothman KI, Moazin MS, Alhgbani M, Baghdadi M, Alotaibi MF. Saudi Urological Association consensus guidelines on the use of robotic surgery in urology. Urol Ann 2022; 14:199-204. [PMID: 36117790 PMCID: PMC9472305 DOI: 10.4103/ua.ua_46_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/01/2022] [Indexed: 11/21/2022] Open
Abstract
Over the past three decades, minimally invasive robotic technology has evolved substantially in urological practice, replacing many open procedures and becoming part of routine clinical practice. The Health Sector Transformation Program for the Kingdom's Vision 2030 aims to restructure the health sector and optimize its status and prospects as an effective and integrated ecosystem centered on the patient's health. Therefore, this consensus seeks to endorse the clinical practice guidelines for robotic surgery (RS) in the KSA, highlighting its effectiveness, safety, and favorable outcomes compared to open and laparoscopic surgeries in certain procedures when used by trained surgeons in well-structured RS programs.
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Affiliation(s)
- Raed A. Azhar
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia,Address for correspondence: Dr. Raed A. Azhar, Department of Urology, Faculty of Medicine, King Abdul-Aziz University, Jeddah, Saudi Arabia. E-mail:
| | - Danny Rabah
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Adel Alammari
- Department of Urology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed Alasker
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia,Department of Surgery, Division of Urology, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ali A. Alqahtani
- Department of Urology, Aseer Central Hospital, Abha, Saudi Arabia
| | - Bader H. Alsaikhan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia,Department of Surgery, Division of Urology, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Fahad A. Alyami
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hassan M. Alzahrani
- Department of Urology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Khalid I. Alothman
- Department of Urology, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Maher S. Moazin
- Department of Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mofarej Alhgbani
- Department of Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Baghdadi
- Department of Surgery, Division of Urology, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mohammed F. Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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Al-Jalabneh T, Al-Shawabkeh O, Al-Gwairy I, Abu-Zeitoun O, Al-Njadat I, Al-Soudi M, Zarour A. Laparoscopic Versus Open Adrenalectomy: a Retrospective Comparative Study. Med Arch 2021; 75:41-44. [PMID: 34012198 PMCID: PMC8116067 DOI: 10.5455/medarh.2021.75.41-44] [Citation(s) in RCA: 3] [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: 12/29/2020] [Accepted: 01/25/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Laparoscopic Adrenalectomy (LA) has rapidly become the gold standard in management of adrenal tumors as it has been found to be associated with better cosmoses, shorter hospital stay and rapid convalescence. OBJECTIVE The aim of this study was to compare laparoscopic and open approach to adrenal glands in terms of operative time, hospital stay, indications and blood loss at a tertiary medical center in Jordan. METHODS A retrospective comparative study which included all patients who underwent adrenalectomy (open or laparoscopic) from 2005 to 2015 at King Hussein Medical Center (KHMC). Patients' demographics ,outcomes and essential study variables were extracted from patients' files. Data analysis was performed using SPSS17 and Stata 10. RESULTS One hundred and three patients (mean age 44.9 years) were included, 90.2% of them underwent laparoscopic adrenalectomy. The size of the tumors ranged from 2 to 17 cm (mean 6.6 cm).The operative time, blood loss and hospital stay were significantly less in the laparoscopic group (P value <0.001). Patients in Open group had a significantly higher risk of incomplete excision of the tumors (P value=0.020). CONCLUSION Laparoscopic adrenalectomy is associated with decreased operative time, blood loss and hospital stay compared to open approach. Tumor size and its malignant potential should be no more regarded as an absolute contraindication to laparoscopic adrenal surgery.
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Affiliation(s)
- Talal Al-Jalabneh
- Laparoscopic and Bariatric Surgery, Department of Surgery, Royal Medical Services, Amman, Jordan
| | - Omar Al-Shawabkeh
- Laparoscopic and Bariatric Surgery, Department of Surgery, Royal Medical Services, Amman, Jordan
| | - Ibrahim Al-Gwairy
- Laparoscopic and Bariatric Surgery, Department of Surgery, Royal Medical Services, Amman, Jordan
| | - Omar Abu-Zeitoun
- Laparoscopic and Bariatric Surgery, Department of Surgery, Royal Medical Services, Amman, Jordan
| | - Ismaieel Al-Njadat
- Laparoscopic and Bariatric Surgery, Department of Surgery, Royal Medical Services, Amman, Jordan
| | - Majdi Al-Soudi
- Breast and Oncology Surgery, Department of Surgery, Royal Medical Services, Amman, Jordan
| | - Ahmad Zarour
- Laparoscopic and Bariatric Surgery, Department of Surgery, Royal Medical Services, Amman, Jordan
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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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Shalaby H, Abdelgawad M, Omar Md M, Zora Md G, Alawwad S, Alameer E, Youssef M, Attia AS, Buell J, Grace L, Kandil E. Robotic and Laparoscopic Approaches for Adrenal Surgery in Obese Patients. Am Surg 2020; 87:588-594. [PMID: 33131284 DOI: 10.1177/0003134820951498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Minimally invasive adrenalectomy is a challenging procedure in obese patients. Few recent studies have advocated against robot-assisted adrenalectomy, particularly in obese patients. This study aims to compare operative outcomes between the robotic and laparoscopic adrenalectomy, particularly in obese patients. MATERIALS AND METHODS A retrospective analysis was performed on all consecutive patients undergoing adrenalectomy for benign disease by a single surgeon using either a laparoscopic or robotic approach. Adrenal surgeries for adrenal cancer were excluded. Demographics, operative time, length of hospital stays, estimated blood loss (EBL), and intraoperative and postoperative complications were evaluated. Patients were divided into 2 groups; obese and nonobese. A sub-analysis was performed comparing robotic and laparoscopic approaches in obese and nonobese patients. RESULTS Out of 120, 55 (45.83%) were obese (body mass index ≥ 30 kg/m2). 14 (25.45%) of the obese patients underwent a laparoscopic approach, and 41 (74.55%) underwent a robotic approach. Operative times were longer in the obese vs. nonobese groups (173.30 ± 72.90 minutes and 148.20 ± 61.68 minutes, P = .04) and were associated with less EBL (53.77 ± 82.48 vs. 101.30 ± 122, P = .01). The robotic approach required a longer operative time when compared to the laparoscopic approach (187 ± 72.42 minutes vs. 126.60 ± 54.55 minutes, P = .0102) in the obese but was associated with less blood loss (29.02 ± 51.05 mL vs. 138.30 ± 112.20 mL, P < .01) and shorter hospital stay (1.73 ± 1.23 days vs. 3.17 ± 1.27 days, P < .001). CONCLUSION Robot-assisted adrenal surgery is safe in obese patients and appears to be longer; however, it provides improvements in postoperative outcomes, including EBL and shorter hospital stay.
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Affiliation(s)
- Hosam Shalaby
- Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA
| | - Mohamed Abdelgawad
- Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA
| | - Mahmoud Omar Md
- Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA
| | - Ghassan Zora Md
- Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA
| | - Saad Alawwad
- Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA
| | - Ehab Alameer
- Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA
| | - Mohanad Youssef
- Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA
| | - Abdallah S Attia
- Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA
| | - Joseph Buell
- Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA
| | - Lee Grace
- Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA
| | - Emad Kandil
- Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA
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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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13
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Ragavan N, Selvaraj N, Raghavan D, Kamalakannan R, Govindaswamy TG, Balakrishnan AK, Jain N. Robot Assisted Laparoscopic Adrenalectomy: Does Size Matter? Cureus 2020; 12:e9887. [PMID: 32968553 PMCID: PMC7502421 DOI: 10.7759/cureus.9887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: Open adrenalectomy (OA) is considered to be the standard care for large adrenal tumors. Minimally invasive surgery (MIS) using laparoscopic technique is considered for many patients in the modern era. Robot assisted laparoscopic adrenalectomy (RALA) can be an extremely useful tool which will negate the disadvantage of laparoscopic method. The aim of the present study is to determine whether adrenal tumor size and laterality have an impact on patients undergoing RALA with respect to perioperative and postoperative outcomes. Methods: During the study period, 38 patients who underwent RALA in a tertiary care center were considered for retrospectively analysis. The study populations were subdivided into distinctive groups based on the tumor size (<5 cm and ≥5 cm, <8 cm and ≥8 cm), and side (right and left side). For all the subgroups, perioperative and postoperative outcomes were analyzed. Perioperative and postoperative outcomes were assessed between patient groups, group a) <5 cm and ≥5 cm tumor, group b) <8 cm and ≥8 cm, and group c) laterality (right vs left). Results: None of the patients showed any differences. In the current study, the conversion rate, readmission, and mortality were not observed. No major complications were noted. Conclusion: RALA appears to be an extremely viable alternative to MIS using laparoscopic technique. The operative time, console time, blood loss, complication rates, and stay were extremely minimal irrespective of the size or laterality of the adrenal tumor.
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14
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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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15
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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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16
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Ito K, Araki H, Uchida T, Manabe Y, Miyazaki Y, Itoh H, Mishina M, Okuno H. Predictive factors and radiological findings of adrenohepatic adhesion during laparoscopic adrenalectomy. Investig Clin Urol 2020; 61:277-283. [PMID: 32377603 PMCID: PMC7189108 DOI: 10.4111/icu.2020.61.3.277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/03/2019] [Indexed: 02/04/2023] Open
Abstract
Purpose This retrospective study aimed to identify predictive factors and imaging features of adrenohepatic adhesion found during laparoscopic right adrenalectomy. Materials and Methods Altogether, 77 patients underwent laparoscopic right adrenalectomy between January 2005 and December 2018. Adrenohepatic adhesion was defined as strict adhesion that required either partial adrenalectomy with coagulation of residual tissue or partial hepatectomy to accomplish complete resection. We assessed their surgical video records to determine if adrenohepatic adhesion was present. Age, sex, body mass index, tumor size, tumor diagnosis and radiological findings (attachment between the liver and the adrenal gland, diameters of the right and left adrenal veins and its ratio) were evaluated as preoperative variables. Results Adrenohepatic adhesion was present in 11 of the 77 patients (14.3%). Age, sex, and body mass index were not statistically significant factors. Tumor size was significantly small in adhesion group (14.2 mm vs. 25.9 mm, p=0.02). Attachment to the liver and adrenal gland was frequently seen regardless of the adhesion. The mean right/left adrenal veins diameters ratio was significantly lower in the adhesion group (0.8 vs. 1.1, p=0.01). Multivariate logistic regression analysis demonstrated the right/left adrenal veins diameters ratio was the only significant predictor of adhesion. The sensitivity, specificity, negative predictive value and positive predictive value were 0.82, 0.76, 0.43, and 0.95 respectively when the optimal cutoff value for the ratio was 0.9 (area under the curve, 0.75; 95% confidence interval, 0.60–0.90). Conclusions The right/left adrenal veins diameters ratio was possible predictor of adrenohepatic adhesion.
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Affiliation(s)
- Katsuhiro Ito
- Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hiromasa Araki
- Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Toshihiro Uchida
- Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yumi Manabe
- Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yu Miyazaki
- Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Haruki Itoh
- Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Mutsuki Mishina
- Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hiroshi Okuno
- Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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17
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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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18
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Abstract
With the recent advances in equipment and surgical techniques, robot-assisted surgery has become accepted and efficient in the surgical field. It is an emerging technology that can safely be applied for a broad spectrum of surgical procedures. As a result of increased ergonomics, three-dimensional view of the operative area and improved moving capacity of the robotic arms with multi-articulation, robotic technology also has found place in adrenal surgery. Recently, robot-assisted adrenal surgery has been adopted widely in many high-volume tertiary centers. Although there are expected theoretical benefits to this approach, the literature is lacking regarding high level evidence. In this review, we will discuss implementation of robotic adrenalectomy as well as perioperative and postoperative measures that helped improved outcomes, offer a comparison of outcomes between conventional laparoscopic adrenalectomy and robotic adrenalectomy and summarize recent developments that may offer evidence for or against a paradigm shift in this specific field of endocrine surgery.
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Affiliation(s)
- Ozer Makay
- Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, Turkey
| | - Varlik Erol
- Department of General Surgery, Gaziosmanpasa Hospital, Yeni Yüzyıl University, Istanbul, Turkey
| | - Murat Ozdemir
- Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, Turkey
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19
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Azhar RA, Elkoushy MA, Aldousari S. Robot-assisted urological surgery in the Middle East: Where are we and how far can we go? Arab J Urol 2019; 17:106-113. [PMID: 31285921 PMCID: PMC6600062 DOI: 10.1080/2090598x.2019.1601003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2018] [Indexed: 12/26/2022] Open
Abstract
Objectives: To evaluate robot-assisted surgery (RAS) in Urology in the Middle East, and its status and future perspectives. Methods: A Medical Literature Analysis and Retrieval System Online (MEDLINE) search was performed using the following keywords: ‘robotics’, ‘robot-assisted surgery’, ‘laparoscopy’, at first with each specific procedure name, such as radical cystectomy, followed by ‘Middle East’ and country names. All abstracts and articles in English that adhered to the scope of the current issue were selected, giving special consideration to relevant landmark articles and those describing trends and the future of RAS in Urology. Results: Only a few index case reports characterised RAS in the Middle East. The Middle East possess only 1% of the da Vinci® Surgical Systems (Intuitive Surgical Inc., Sunnyvale, CA, USA) installed worldwide, including 19 in Saudi Arabia; six in Qatar; two in each of Kuwait and Lebanon; three in the United Arab Emirates; and only one in Egypt. The total number of RAS performed in the Middle East is low compared to Europe and the USA. Many countries in the Middle East still lack surgical robots despite having the expertise and appropriate caseload, whilst others seem not to utilise the surgical robot at a suitable rate, as reflected by the sparse number of operated cases and outgoing publications. There are major differences in RAS availability, usage, and perception according to the geographical place of practice and acceptance of robots by surgeons and patients. Conclusion: RAS in Urology continues to grow in the Middle East, with increasing caseloads and diversity of operated cases. Acceptance of robots by Middle East surgeons is significantly increasing. Abbreviations: 3D: three-dimensional; KSA: Kingdom Saudi Arabia;MIS: minimally invasive surgery; RAA: robot-assisted adrenalectomy; RAP: robot-assisted pyeloplasty; (O)(RA)PN: (open) (robot-assisted) partial nephrectomy; RAS: robot-assisted surgery; (O)(RA)RC: (open) (robot-assisted) radical cystectomy; (RA)RP: (robot-assisted) radical prostatectomy; SAUC: Sabah Al-Ahmad Urology Center
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Affiliation(s)
- Raed A Azhar
- Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohamed A Elkoushy
- Department of Urology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Saad Aldousari
- Department of Surgery, Urology Unit, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
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20
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Cochetti G, Paladini A, Boni A, Silvi E, Tiezzi A, De Vermandois JAR, Mearini E. Robotic treatment of giant adrenal myelolipoma: A case report and review of the literature. Mol Clin Oncol 2019; 10:492-496. [PMID: 31007910 PMCID: PMC6467000 DOI: 10.3892/mco.2019.1823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 02/13/2019] [Indexed: 02/07/2023] Open
Abstract
Adrenal myelolipoma is a rare mesenchymal tumour with benign biological behaviour that is mainly composed of mature adipose and myeloid tissue. Both sexes are equally affected, most commonly between the fifth and seventh decades of life. The diagnosis of adrenal myelolipoma is mostly incidental. Although it may occasionally be associated with necrosis, rupture and haemorrhage, causing abdominal pain, this tumour is usually asymptomatic. Consequently, management is conservative, while surgical treatment is reserved for symptomatic cases, or for masses growing quickly or to a size >6 cm. Giant myelolipomas (sized >10 cm) are rare. Open radical adrenalectomy is the standard treatment for giant myelolipomas, while the minimally invasive approach has been used in only few cases. We herein report the case of a patient with a giant adrenal myelolipoma who underwent robotic partial adrenalectomy. To the best of our knowledge, this is the largest giant adrenal myelolipoma treated with robotic surgery reported in the literature to date. A 55-year-old male patient underwent an abdominal computed tomography scan during follow-up after radical prostatectomy for prostate cancer Gleason Score 6 (ISUP 1) due to biochemical recurrence. The examination revealed a right hypodense adrenal mass, sized 16×13 cm. Abdominal magnetic resonance imaging confirmed the presence of characteristics suggestive of a myelolipoma. The patient did not report any symptoms. Due to the benign characteristics of the mass, robotic partial adrenalectomy and enucleation of the mass were performed. The operative time and estimated blood loss were 205 min and 100 ml, respectively. No intra- or postoperative complications occurred. The patient was mobilized on the first postoperative day and the time to flatus was 36 h; the length of hospitalization was 4 days. Histological examination confirmed the diagnosis of adrenal myelolipoma, sized 18×11.5×6 cm. No tumour recurrence occurred over a follow-up period of 12 months. In conclusion, robotic surgery allows performing partial adrenalectomy with a lower risk of bleeding and with preservation of healthy adrenal tissue, which is of paramount importance for the patient as it reduces recovery time and the need for medical substitution therapy.
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Affiliation(s)
- Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, Inter-Divisional Urology Clinic (Perugia-Terni), Santa Maria della Misericordia University Hospital, I-06156 Perugia, Italy
| | - Alessio Paladini
- Department of Surgical and Biomedical Sciences, Inter-Divisional Urology Clinic (Perugia-Terni), Santa Maria della Misericordia University Hospital, I-06156 Perugia, Italy
| | - Andrea Boni
- Department of Surgical and Biomedical Sciences, Inter-Divisional Urology Clinic (Perugia-Terni), Santa Maria della Misericordia University Hospital, I-06156 Perugia, Italy
| | - Elisa Silvi
- Department of Surgical and Biomedical Sciences, Inter-Divisional Urology Clinic (Perugia-Terni), Santa Maria della Misericordia University Hospital, I-06156 Perugia, Italy
| | - Alberto Tiezzi
- Department of Surgical and Biomedical Sciences, Inter-Divisional Urology Clinic (Perugia-Terni), Santa Maria della Misericordia University Hospital, I-06156 Perugia, Italy
| | - Jacopo Adolfo Rossi De Vermandois
- Department of Surgical and Biomedical Sciences, Inter-Divisional Urology Clinic (Perugia-Terni), Santa Maria della Misericordia University Hospital, I-06156 Perugia, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Inter-Divisional Urology Clinic (Perugia-Terni), Santa Maria della Misericordia University Hospital, I-06156 Perugia, Italy
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21
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Quadri P, Esposito S, Coleoglou A, Danielson KK, Masrur M, Giulianotti PC. Robotic Adrenalectomy: Are We Expanding the Indications of Minimally Invasive Surgery? J Laparoendosc Adv Surg Tech A 2018; 29:19-23. [PMID: 30265584 DOI: 10.1089/lap.2018.0286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Laparoscopic adrenalectomy (LA) is accepted as the gold standard treatment for most adrenal pathologies. Open surgery is still considered the standard of care for large tumors and malignancies. In the past decade, robotic adrenalectomy (RA) has become an alternative to the laparoscopic and open approaches. The aim of this study was to analyze perioperative and postoperative outcomes in a series of consecutive nonselected patients undergoing a RA, to determine whether factors that negatively affect outcomes in LA (body mass index [BMI], size, and side of the tumor) have the same impact in RA. MATERIALS AND METHODS This is a single-center single-surgeon retrospective study with 43 patients who underwent a RA. Patients were divided into different groups according to tumor size (cutoff values of 5 or 8 cm), tumor side (left/right), and BMI (cutoff value of kg/m2). Perioperative and postoperative outcomes included operative time, length of hospital stay, blood loss, readmissions, complications, and conversions to open. RESULTS There were no significant differences between the groups with tumors <5 cm versus ≥5 cm regarding gender, age, race, BMI, American Society of Anesthesiologists (ASA) score, history of previous abdominal surgery, tumor side, and histopathological diagnosis (all P values ≥.06). There were no significant differences in any of the outcomes analyzed with respect to the tumor size (all P values ≥.14) except for a higher occurrence of complications in patients with tumors ≥8 cm versus <8 cm (P = .03). There were no significant differences in any outcomes related to side (left versus right) of the tumor nor BMI (<30 versus ≥30 kg/m2). The overall readmission and conversion rates were both 2.3% and no mortalities were registered. CONCLUSION Patient's BMI, tumor side, and size did not demonstrate a negative impact on perioperative and postoperative outcomes of RA. This approach could potentially expand the indications of minimally invasive surgery.
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Affiliation(s)
- Pablo Quadri
- 1 Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Sofia Esposito
- 2 Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois
| | - Adrian Coleoglou
- 1 Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Kirstie K Danielson
- 1 Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois.,2 Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois
| | - Mario Masrur
- 1 Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Pier C Giulianotti
- 1 Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
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22
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Honda M, Morizane S, Hikita K, Takenaka A. Current status of robotic surgery in urology. Asian J Endosc Surg 2017; 10:372-381. [PMID: 28905493 DOI: 10.1111/ases.12381] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/08/2017] [Indexed: 12/12/2022]
Abstract
As a result of ergonomics, optimal magnification of the operative field, surgeon dexterity, and precision of surgical manipulation, robotic technology has been shown to overcome many difficulties associated with pure laparoscopy. With the recent expansion of robot-assisted surgery in the field of urology and following the success of robot-assisted prostatectomy and robot-assisted partial nephrectomy, robot-assisted surgery is being applied to treat many other genitourinary diseases, such as bladder cancer and ureteropelvic junction obstruction. The aim of the present review is to discuss the role of robotic surgery in urology and summarize recent developments in the field of urologic robotic surgery.
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Affiliation(s)
- Masashi Honda
- Department of Urology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Shuichi Morizane
- Department of Urology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Katsuya Hikita
- Department of Urology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Atsushi Takenaka
- Department of Urology, Tottori University Faculty of Medicine, Yonago, Japan
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23
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Minimally Invasive Adrenalectomy for Adrenocortical Carcinoma: Five-Year Trends and Predictors of Conversion. World J Surg 2017; 42:473-481. [DOI: 10.1007/s00268-017-4290-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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Nomine-Criqui C, Germain A, Ayav A, Bresler L, Brunaud L. Robot-assisted adrenalectomy: indications and drawbacks. Updates Surg 2017; 69:127-133. [DOI: 10.1007/s13304-017-0448-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 04/09/2017] [Indexed: 12/27/2022]
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25
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Affiliation(s)
- Glen Denmer Santok
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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