Robot-assisted adrenalectomy: current perspectives

Pahwa, Mrinal

doi:10.2147/rsrr.s100887

Cited by 13 publications

(19 citation statements)

References 51 publications

(51 reference statements)

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“…One of the most significant concerns about robot-assisted surgery regards its prohibitive costs. The elevated cost associated with robotic surgery is primarily related to the purchase and the maintenance of the unit, the high instruments cost, the use of semi-disposable instruments and the longer operative time [15].…”

Section: Cost-effectivenessmentioning

confidence: 99%

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Robot-assisted adrenalectomy: state of the art

Materazzi

Rossi

2020

Updates Surg

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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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Section: Cost-effectivenessmentioning

confidence: 99%

“…Moreover, due to the additional steps required, such as the docking of the robotic tower, a prolonged operative time is acknowledged [12,14]. Last but not least, the major drawback of the robotic surgery is represented by the elevated costs of the purchase and for the maintenance of the unit [15,16].…”

Section: Introductionmentioning

confidence: 99%

Robot-assisted adrenalectomy: state of the art

Materazzi

Rossi

2020

Updates Surg

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“…After the first LA was defined in 1992, different surgical techniques such as LTAA, LTLA, and LRPA, and LRLA approach were developed (8,9). With the advent of robotic surgery in recent years, RA has become an alternative to traditional LA (10). There are advantages and disadvantages of the 4 different approaches defined for LA.…”

Section: Discussionmentioning

confidence: 99%

“…After the first definition of laparoscopic adrenalectomy (LA) by Gagner in 1992, different surgical techniques such as the laparoscopic transperitoneal [anterior (LTAA), lateral (LTLA)] and retroperitoneal [posterior (LRPA), lateral (LRLA)] approach were developed (8,9). With the advent of robotic surgery in recent years, roboticassisted adrenalectomy (RA) has become an alternative to traditional LA (10).…”

Section: Introductionmentioning

confidence: 99%

Adrenalektomi Yapılan Hastalarda Klinik Endikasyon ve Cerrahi Yöntemlerin Değerlendirilmesi

Durhan¹,

Süleyman²

2021

Ankara Eğitim Ve Araştırma Hastanesi Tıp Dergisi

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The aim of this study was to evaluate the clinical surgical indications, surgical method selection criteria, and histopathological results of patients who were operated on with the diagnosis of adrenal mass in our general surgery clinic. MATERIAL AND METHOD:A retrospective analysis was made of the data retrieved from the hospital database of patients who underwent surgery for adrenal mass in our general surgery clinic between January 2016 and January 2021. The data examined included demographic characteristics, American Anesthesiologists Association (ASA) score, preoperative clinical diagnosis, surgical technique, perioperative complications, duration of hospital stay, and histopathological results.RESULTS: A total of 16 patients underwent surgery for a diagnosis of adrenal mass in the specified study period. The patients comprised 13 (81.25%) females and 3 (18.75%) males with a mean age of 50.31 ± 15.06 years, and mean ASA score of 1.87 ± 0.61. Surgery was performed by open adrenalectomy (OA) in 3 (18.75%) cases and laparoscopic transperitoneal lateral adrenalectomy (LTLA) in 13 (81.25%) cases. The preoperative clinical diagnosis was functional tumour in 10 (62.5%) patients and non-functional mass in 6 (37.5%). CONCLUSION:Although adrenal gland tumors are extremely rare, a multidisciplinary approach is very important at the stages of diagnosis, surgical method selection, and postoperative followup. Surgeons should select the surgical method in which they are most experienced and trained, to be able to obtain the best results considering the risk factors.

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“…Less invasive procedures and partial adrenalectomy, which is feasible also by robotic surgery, are emerging options to preserve remnant adrenal function and avoid adrenal insufficiency [ [181] , [182] , [183] ]. However, they should be guided by super-selective AVS, a sophisticated refinement of AVS that is currently performed in only few centers in Japan (Class of Recommendation II, Level of Evidence C) [ 184 ].…”

Section: Treatmentmentioning

confidence: 99%