Introduction: With the advances in technology, there has been a recent interest in using the robot for general surgical procedures. A number of reports has demonstrated the safety of robotic lateral adrenalectomy with scant comparison data. Nevertheless, the posterior approach has not been described using the robot. The aim of this study was to develop techniques of robotic lateral and posterior adrenalectomy and compare results to conventional laparoscopic approach.
Methods and Procedures: Within a year, 15 patients underwent robotic and 20 patients laparoscopic adrenalectomy in an endocrine surgical program. IRB approval was obtained. Data regarding demographics, type of procedure, tumor type and size, location (left or right), operative time, blood loss, complications and length of hospital stay were compared. Statistical analyses were performed using t- and chi-square tests.
Results: The groups were similar regarding gender (robotic 13 women, 2 men; laparoscopic 16 women, 4 men) and age (robotic 54.9 +/- 3.5;laparoscopic 55.4 +/- 2.9 years, p=NS). Type of procedure included 11 lateral transabdominal and 4 posterior retroperitoneal adrenalectomy in the robotic versus 13 lateral transabdominal and posterior retroperitoneal in the laparoscopic group (p=NS). Pathology was adrenocortical adenoma (n=8), pheochromocytoma (n=4), Cushing’s (n=2) and symptomatic adrenal cyst (n=1) in the Robotic and Cushing’s (n=7), pheochromocytoma (n=5), adrenocortical adenoma (n=5), and aldosteronoma (n=3) in the Laparoscopic group (p=NS). Tumor size was 4.2 +/- 0.5 cm in the Robotic versus 3.7 +/- 0.4 cm in the Laparoscopic group (p=NS). Skin to skin operating time was 177.6 +/- 15.3 minutes in the Robotic and 173.6 +/- 12.8 minutes in the Laparoscopic group (p=NS). There was no peri-operative complication in either group. There was no difference between the 2 groups regarding right versus left location, estimated blood loss, and hospital stay. Subjectively, overall ergonomics, visual clarity and ease of dissection were felt to be better with the Robotic approach by the study surgeons.
Conclusion: This initial study shows that robotic adrenalectomy is equivalent to the laparoscopic approach regarding peri-operative outcomes, with better visualization and easier manipulation.
Program Number: P483