Robot-Assisted Total and Partial Adrenalectomy

Abstract

Since the first laparoscopic adrenalectomy was performed in 1992 (Gagner M, Lacroix A, Bolte E, N Engl J Med 327:1033, 1992), minimally invasive approaches to the treatment of benign and malignant diseases of the adrenal gland have become increasingly common (Cyriac J, Weizman D, Urbach DR, Expert Rev Med Devices 3:777–786, 2006; Guazzoni G, Cestari A, Montorsi F et al., BJU Int 93:221–227, 2004; Hazzan D, Shiloni E, Golijanin D et al., Surg Endosc 15:1356–1358, 2001; Liao CH, Chueh SC, Lai MK et al., J Clin Endocrinol Metab 91:3080–3083, 2006; Tsuru N, Ushiyama T, Suzuki K, J Endourol 19:702–708, 2005, discussion 708–709; Valeri A, Borrelli A, Presenti L et al., Surg Endosc 15:90–93, 2001; Zeh HJ, 3rd, Udelsman R, Ann Surg Oncol 10:1012–1017, 2003). A minimally invasive approach to adrenalectomy is now considered the standard of care for most adrenal surgeries due to the reduced morbidity and improved outcomes. A minimally invasive approach to adrenalectomy has been shown to be safe, reduces morbidity, and shortens convalescence when compared to a conventional open approach (Fazeli-Matin S, Gill IS, Hsu TH et al., J Urol 162:665–669, 1999; Hallfeldt KK, Mussack T, Trupka A et al., Surg Endosc 17:264–267, 2003; Jacobsen NE, Campbell JB, Hobart MG, Can J Urol 10:1995–1999, 2003; Kirshtein B, Yelle JD, Moloo H et al., J Laparoendosc Adv Surg Tech A 18:42–46, 2008). The incorporation of robotic assistance to adrenal surgery occurred in 2001 when Horgan and Vanuno performed the first robot-assisted bilateral adrenalectomy (Horgan S, Vanuno D, J Laparoendosc Adv Surg Tech A 11:415–419, 2001). Since then, a number of other centers have published their experiences with robot-assisted adrenal surgey (Horgan S, Vanuno D, J Laparoendosc Adv Surg Tech A 11:415–419, 2001; Brunaud L, Bresler L, Ayav A et al., Am J Surg 195:433–438, 2008; Brunaud L, Bresler L, Zarnegar R et al., World J Surg 28:1180–1185, 2004; Desai MM, Gill IS, Kaouk JH et al., Urology 60:1104–1107, 2002; Gill IS, Sung GT, Hsu TH et al., J Urol 164: 2082–2085, 2000; Krane LS, Shrivastava A, Eun D et al., BJU Int 101:1289–1292, 2008; Moinzadeh A, Gill IS, Urol Clin North Am 31:753–756, 2004; Rogers CG, Blatt AM, Miles GE et al., J Endourol 22:1501–1503, 2008; Sung GT, Gill IS, Surg Clin North Am 83:1469–1482, 2003; Wu JC, Wu HS, Lin MS et al., J Formos Med Assoc 104:748–751, 2005; Young JA, Chapman WH, 3rd, Kim VB et al., Surg Laparosc Endosc Percutan Tech 12: 126–130, 2002). The robotic approach has several potential advantages when compared to laparoscopy including three-dimensional magnified vision, seven degrees of freedom, miniature instruments, tremor reduction, and improved ergonomics. Robotic assistance may facilitate a minimally invasive approach to urologic procedures that require precise reconstruction and intracorporeal suturing. While adrenalectomy does not require reconstruction, the robot may be useful for the delicate dissection of large blood vessels, such as the aorta, vena cava, and renal vessels, and of organs such as the liver and spleen. In this chapter we present the techniques of right and left transperitoneal robot-assisted adrenalectomy. We also describe robot-assisted partial adrenalectomy and review the literature regarding robot-assisted adrenalectomy.