Robot-assisted laparoscopic adrenalectomy

Abstract

The laparoscopic technology has presented new frontiers to adrenal surgery thus enabling modification and refinement of established conventional procedures. The integration of robots into adrenal surgery has made it feasible to offer alternatives to patients requiring surgical treatment of adrenal disorders. The robotic assistance may allow more surgeons, with limited conventional laparoscopic experience to offer to their patients a mini invasive approach. Indications for robotic adrenalectomy mirror those of laparoscopic adrenalectomy and include most adrenal tumors, except those concerning adrenocortical carcinoma, which should still be approached preferably with open surgery. Surgical approach (transperitoneal or retroperitoneal) is determined by surgical goals, patient medical and surgical history and surgeon experience. In studying minimal access adrenalectomy techniques, the effect of operative volume and experience of the surgeon needs to be taken into consideration. A Systematic review and a meta-analysis of current evidence show that robot-assisted adrenalectomy can be performed safely and effectively with operative time and complication rates similar to laparoscopic adrenalectomy. In addition it can provide the potential advantage of a shorter hospital stay and less blood loss. These findings seem to support the use of robotic surgery for the minimally invasive surgical management of adrenal masses.