Robotic adrenalectomy in patients with pheochromocytoma: a systematic review

Abstract

Pheochromocytomas (PHEOs) are neural crest cell tumors producing catecholamines. PHEOS need to be early diagnosed and adequately managed. Adrenalectomy is the gold standard treatment of these type of tumors. There has been major improvement of surgical technologies with the development of laparoscopic and robotic systems these past several years. We conducted a review of the literature to evaluate the robotic approach for adrenalectomy for patients with PHEO.

Robotic adrenalectomy versus laparoscopic adrenalectomy for pheochromocytoma: a systematic review and meta-analysis.

“…Most of the PHEOs are rich in blood vessels and catecholamine-secreting tumours. Haemodynamic crisis is the most challenging factor during the manipulation of the tumour [17,18] tactile feedback, many researchers were concerned about the risk of bleeding, cardiovascular accidents, and intraoperative hypertensive crisis during the dissection of PHEO [8]. Our study found similar peri-operative haemodynamic outcomes between the 2 groups.…”

“…However, the longer learning curve, longer operative time, and higher costs limit the application of robotic surgery [7]. In addition, due to the lack of tactile feedback during dissection of PHEO, RA could increase the risk of bleeding, cardiovascular accidents, and intraoperative hypertensive crisis [8].…”

Comparing perioperative outcomes of robotic-assisted laparoscopic adrenalectomy and laparoscopic adrenalectomy in the treatment of large adrenal tumors (≥5 cm): a propensity-matched score analysis

“…It is well known that pheochromocytoma can secrete catecholamines paroxysmal, and is rich in blood vessels, which easily leads to intraoperative hemodynamic instability and increased intraoperative blood loss (23). Results of a meta-analysis indicated that RALA may increase the risk of bleeding, cardiovascular accident, and intraoperative hypertensive crisis due to a lack of tactile feedback during pheochromocytoma dissection (24). Nonetheless, a randomized controlled trial reported that both RALA and LA were safe and effective in the treatment of pheochromocytoma.…”

An Overview on Pheochromocytoma Diagnosis and Management Approach, Review Article

“…There is some evidence that the retroperitoneal approach is superior to transabdominal but it is not concrete and requires more research. (Nehs & Ruan, 2011;Aliyev et al, 2013;Nomine-Criqui et al, 2015;Bihain et al, 2020) A key difference between sporadic cases and patients with a familial disorder is that the latter has a high risk of bilateral disease unlike the former. Therefore, in sporadic cases, we opt for complete removal of the adrenal because the vast majority are unilateral.…”