Robot-assisted Laparoscopic Adrenalectomy: Step-by-Step Technique and Comparative Outcomes

被引:57
作者
Brandao, Luis Felipe [1 ]
Autorino, Riccardo [1 ]
Zargar, Homayoun [1 ]
Krishnan, Jayram [1 ]
Laydner, Humberto [1 ]
Akca, Oktay [1 ]
Mir, Maria Carmen [1 ]
Samarasekera, Dinesh [1 ]
Stein, Robert [1 ]
Kaouk, Jihad [1 ]
机构
[1] Cleveland Clin, Glickman Urol & Kidney Inst, Cleveland, OH 44195 USA
关键词
Adrenalectomy; Laparoscopy; Surgical technique; Robotic surgery; RETROPERITONEOSCOPIC ADRENALECTOMY; ADRENOCORTICAL CARCINOMA; SINGLE; EXPERIENCE; TRANSPERITONEAL;
D O I
10.1016/j.eururo.2014.04.003
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background: Recent evidence supports the use of robotic surgery for the minimally invasive surgical management of adrenal masses. Objective: To describe a contemporary step-by-step technique of robotic adrenalectomy (RA), to provide tips and tricks to help ensure a safe and effective implementation of the procedure, and to compare its outcomes with those of laparoscopic adrenalectomy (LA). Design, setting, and participants: We retrospectively reviewed the medical charts of consecutive patients who underwent RA performed by a single surgeon between April 2010 and October 2013. LA cases performed by the same surgeon between January 2004 and May 2010 were considered the control group. Surgical procedure: The main steps of our current surgical technique for RA are described in this video tutorial: patient positioning, port placement, and robot docking; exposure of the adrenal gland; identification and control of the adrenal vein; circumferential dissection of the adrenal gland; and specimen retrieval and closure. Outcome measurements and statistical analysis: Demographic parameters and main surgical outcomes were assessed. Results and limitations: A total of 76 cases (RA: 30; LA: 46) were included in the analysis. Median tumor size on computed tomography (CT) was significantly larger in the LA group (3 cm [interquartile range (IQR): 3] vs 4 cm [IQR: 3]; p = 0.002). A significantly lower median estimated blood loss was recorded for the robotic group (50 ml [IQR: 50] vs 100 ml [IQR: 288]; p = 0.02). The RA group presented five minor complications (16.7%) and one major (Clavien 3b) complication (3.3%), whereas four minor complications (8.7%) and one major (Clavien 3b) complication (2.3%) were observed in the LA group. No significant difference was noted between groups in terms of malignant histology (p = 0.66) and positive margin rate (p = 0.60). Distribution of pheochromocytomas in the LA group was significantly higher than in the RA group (43.5% vs 16.7%; p = 0.02). Conclusions: The standardization of each surgical step optimizes the RA procedure. The robotic approach can be applied for a wide range of adrenal indications, recapitulating the safety and effectiveness of open surgery and potentially improving the outcomes of standard laparoscopy. Patient summary: In this report we detail our surgical technique for robotic removal of adrenal masses. This procedure has been standardized and can be offered to patients, with excellent outcomes. (C) 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
引用
收藏
页码:898 / 905
页数:8
相关论文
共 23 条
  • [1] Agcaoglu O, 2012, ARCH SURG-CHICAGO, V147, P272, DOI 10.1001/archsurg.2011.2040
  • [2] Robotic versus laparoscopic adrenalectomy in obese patients
    Aksoy, Erol
    Taskin, Halit Eren
    Aliyev, Shamil
    Mitchell, Jamie
    Siperstein, Allan
    Berber, Eren
    [J]. SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2013, 27 (04): : 1233 - 1236
  • [3] Robotic Versus Laparoscopic Adrenalectomy for Pheochromocytoma
    Aliyev, Shamil
    Karabulut, Koray
    Agcaoglu, Orhan
    Wolf, Katherine
    Mitchell, Jamie
    Siperstein, Allan
    Berber, Eren
    [J]. ANNALS OF SURGICAL ONCOLOGY, 2013, 20 (13) : 4190 - 4194
  • [4] Robotic Versus Laparoscopic Adrenalectomy: A Systematic Review and Meta-analysis
    Brandao, Luis Felipe
    Autorino, Riccardo
    Laydner, Humberto
    Haber, Georges-Pascal
    Ouzaid, Idir
    De Sio, Marco
    Perdona, Sisto
    Stein, Robert J.
    Porpiglia, Francesco
    Kaouk, Jihad H.
    [J]. EUROPEAN UROLOGY, 2014, 65 (06) : 1154 - 1161
  • [5] Robotic-assisted adrenalectomy: what advantages compared to lateral transperitoneal laparoscopic adrenalectomy?
    Brunaud, Laurent
    Bresler, Laurent
    Ayav, Ahmet
    Zarnegar, Rasa
    Raphoz, Anne-Laure
    Levan, Than
    Weryha, Georges
    Boissel, Patrick
    [J]. AMERICAN JOURNAL OF SURGERY, 2008, 195 (04) : 433 - 438
  • [6] Robot-assisted Adrenalectomy
    Brunaud, Laurent
    Germain, Adeline
    Zarnegar, Rasa
    Cuny, Thomas
    Ayav, Ahmet
    Bresler, Laurent
    [J]. SURGICAL LAPAROSCOPY ENDOSCOPY & PERCUTANEOUS TECHNIQUES, 2011, 21 (04) : 248 - 254
  • [7] Increased Complication Rate in Obese Patients Undergoing Laparoscopic Adrenalectomy
    Dancea, Horatiu C.
    Obradovic, Vladan
    Sartorius, Jennifer
    Woll, Nicole
    Blansfield, Joseph A.
    [J]. JSLS-JOURNAL OF THE SOCIETY OF LAPAROENDOSCOPIC SURGEONS, 2012, 16 (01) : 45 - 49
  • [8] Robotic-assisted laparoscopic adrenalectomy
    Desai, MM
    Gill, IS
    Kaouk, JH
    Matin, SF
    Sung, GT
    Bravo, EL
    [J]. UROLOGY, 2002, 60 (06) : 1104 - 1107
  • [9] Dickson PV, 2013, AM SURGEON, V79, P84
  • [10] Robot-assisted adrenalectomy: a technical option for the surgeon?
    Giulianotti, P. C.
    Buchs, N. C.
    Addeo, P.
    Bianco, F. M.
    Ayloo, S. M.
    Caravaglios, G.
    Coratti, A.
    [J]. INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, 2011, 7 (01) : 27 - 32