Robotic Surgery Is Unnecessary for Adrenalectomy

Abstract

The word unnecessary is provocative. To begin, we have to define necessity. If one argues the other way around—a robot is necessary for adrenalectomy—it implies that everybody in world who does not use a robot for this indication in wrong. In contrast, the given title, including the small word unnecessary, implies that everybody who uses a robot for this indication is somehow extravagant. What is the truth? Brandao et al [1] recently published a systematic review and meta-analysis on this topic. The conclusion remained unclear. That robotic adrenalectomy is safe and feasible is without doubt and is not very surprising, but the potential advantages of shorter hospital stay and lower blood loss are not so clear. A shorter hospital stay for reasons other than ‘‘we know better today’’ can be explained only by less trauma and pain with one approach. Robotic adrenalectomy is just another form of laparoscopic approach (as used in this paper, laparoscopic approach includes the retroperitoneoscopic approach), so it is not logical that the robotic procedure should cause less trauma for the patient. This is different from the open approach, which has largely been replaced by laparoscopy as the standard of care for the vast majority of adrenal surgery, given demonstrated advantages such as less postoperative pain, minor blood loss, and better cosmetic appearance [1]. Less blood loss with one technique versus the other is important only if it is clinically meaningful. A difference of 50 ml (50 vs 100 ml) is most probably not clinically meaningful. As surgeons with broad laparoscopic experience, adrenalectomy is an ‘‘easy’’ indication in urologic surgery; it is performed for rather small masses and is usually bloodless or has only minor bleeding! The authors [1] also reported no significant differences between groups in terms of clinically meaningful outcomes like intraoperative complication rate (p = 0.23),