Robot Assisted Laparoscopic Adrenalectomy: Does Size Matter?

Narasimhan Ragavan,Deepak Raghavan,Ramesh Kamalakannan,Arun Kumar Balakrishnan,Nivash Selvaraj,Nitesh Jain,Thirumalai Ganesan Govindaswamy

doi:10.7759/cureus.9887

Abstract

Objective: Open adrenalectomy (OA) is considered to be the standard care for large adrenal tumors. Minimally invasive surgery (MIS) using laparoscopic technique is considered for many patients in the modern era. Robot assisted laparoscopic adrenalectomy (RALA) can be an extremely useful tool which will negate the disadvantage of laparoscopic method. The aim of the present study is to determine whether adrenal tumor size and laterality have an impact on patients undergoing RALA with respect to perioperative and postoperative outcomes. Methods: During the study period, 38 patients who underwent RALA in a tertiary care center were considered for retrospectively analysis. The study populations were subdivided into distinctive groups based on the tumor size (<5 cm and ≥5 cm, <8 cm and ≥8 cm), and side (right and left side). For all the subgroups, perioperative and postoperative outcomes were analyzed. Perioperative and postoperative outcomes were assessed between patient groups, group a) <5 cm and ≥5 cm tumor, group b) <8 cm and ≥8 cm, and group c) laterality (right vs left).Results: None of the patients showed any differences. In the current study, the conversion rate, readmission, and mortality were not observed. No major complications were noted.Conclusion: RALA appears to be an extremely viable alternative to MIS using laparoscopic technique. The operative time, console time, blood loss, complication rates, and stay were extremely minimal irrespective of the size or laterality of the adrenal tumor.

Highlights

Adrenalectomy is the standard operation for the adrenal tumors
Many studies as well as meta-analyses demonstrated robotic adrenalectomy (RA) supremacy over open adrenalectomy (OA) and laparoscopic adrenalectomy (LA) [4,5,6].The disadvantages of Robot assisted laparoscopic adrenalectomy (RALA) include higher cost and accessibility which prevented it from becoming worldwide acceptance for adrenalectomy
Adrenalectomies done for the suspected metastatic disease, bilateral adrenalectomies as well as adrenalectomy with concomitant procedures such as nephrectomies were excluded from the study

Summary

Introduction

Adrenalectomy is the standard operation for the adrenal tumors. Adrenalectomies are done by open method especially for tumors more than 5 cm in view of the possibility of malignancy [1]. Laparoscopic adrenalectomy (LA) is viewed as the favored procedure of choice for adrenal tumors. Many studies as well as meta-analyses demonstrated robotic adrenalectomy (RA) supremacy over open adrenalectomy (OA) and LA [4,5,6].The disadvantages of RALA include higher cost and accessibility which prevented it from becoming worldwide acceptance for adrenalectomy. A tumor size of more than 5 cm is still believed to be a contraindication for minimally invasive procedures and the standard of care seems to be an open approach. We share the experience of 38 patients undergoing RALA for various adrenal lesions

Methods

Results

Conclusion