Robot-assisted Laparoscopic Adrenalectomy Research Articles

Clinical study of robot-assisted laparoscopic surgery for complicated adrenal tumors that unfit for conventional laparoscopic adrenalectomy

Objective To discuss the feasibility,safety and efficacy of robot-assisted laparoscopic adrenalectomy(RALA) in the treatment of complicated adrenal tumors that unfit for conventional laparoscopic adrenalectomy.Methods Fourteen patients with complicated adrenal tumors underwent RALA from August 2012 to March 2013.Five patients were male and 9 patients were female.Preoperative ultrasound and CT scan indicated that tumors of 10 patients were in the left side,and 4 in the right.Images showed that the maximum diameters of the tumors were 2.5-10.0 cm,with an average of 5.2 cm.The reasons to choose RALA were as follows:large tumors (≥5 cm) in 9 cases,patients' overweight or obesity in 7 cases,the need or the desire to save the normal adrenal tissue in a great extent in 4 cases,tumors compressing large vessels or important organs in 3 cases,the possibility that the tumor may be a metastasis in 1 case.Six cases had 2 or more reasons described above.All surgeries were pedormed by lateral transperitoneal approach started with the paracolic gutter.General anesthesia was used in all cases.Four trocars (3 robotic arms and 1 assistant port) were used in the left-sided adrenalectomies and 5 trocars (3 robotic arms and 2 assistant ports) were used in the right-sided adrenalectomies.Results All the operations were successful without conversion to open surgery.The mean docking time of da Vinci surgical system was 10 min.The operative time was 30-120 min,with an average of 73 min.The estimated blood loss was 10-400 ml,with an average of 111 ml.No transfusion was needed during the surgeries.The length of postoperative hospital stay was 4.0-10.0 d,with an average of 5.7 d.Postoperative pathology showed pheochromocytoma in 3 cases (including 1 paraganglioma),macronodular adrenal hyperplasia in 1 case,adenoma with hyperplasia in 2 cases,adenoma in 4 cases,myelolipoma in 1 case,metastatic tumor in 1 case,large cyst in 1 case,calcified cyst in 1 case.No recurrence was found during the follow-up of 2 to 10 months.Conclusion For patients with adrenal tumors that unfit for conventional laparoscopic surgery,RALA may provide an alternative option for the advantage of delicate manipulation and three-dimensional magnifying image. Key words: Robotics; Laparoscopes; Adrenal gland neoplasms; Adrenalectomy

Initial experience of a series of robotic-assisted laparoscopic adrenalectomy

ObjectivesWe present our initial experience using robotic-assisted laparoscopic adrenalectomy in the surgical treatment of adrenal masses. Material and methodsA total of 18 patients (11 women and 7 men) diagnosed of a functioning or non-functioning adrenal tumor mass were operated on in our facilities between October 2009 and October 2011. Surgical variables, intra-hospital recovery time, pathological findings and peri- and post-operatory findings were evaluated. ResultsMean age of the population intervened was 51.2 years (range 18–81), average ASA score 2.11 (range 1–4) and BMI 27.0 (range 18.8–36.1). Of the 18 patients, 11 were operated on the left side and 7 on the right. Mean surgery time was 150 (range 84–329) min and intra-operatory bleeding 121 (range 10–1500) ml, with a mean loss of hemoglobin and hematocrits of 2.11g/dl and 6.33%, respectively. Two patients were converted to conventional surgery. The factors influencing surgical conversion were: normal size (>10cm), tumor weight (>100g), active pheochromocytoma and left localization of the tumor. Seven functioning cortical adenomas, 6 metastatic adrenal tumors, 3 pheochromocytoma and 2 incidental tumors were excised. Mean tumor size was 5.39 (range 3–15) cm. Median hospital stay was 6 days (range 4–14). Five patients had peri-operatory complication. Of these, only one (5%) had major complications (Clavien III). Mean follow-up was 6 months (range 2–24). ConclusionsRobotic technology for laparoscopic adrenalectomies is a valid option for adrenal tumor treatment. In our experience with a relatively short learning curve, it makes it possible to reduce hospital treatment times and the intra- and post-operatory complications, without affecting the oncological and post-operatory functional results.

Adrenal Nodular Hyperplasia in Hereditary Leiomyomatosis and Renal Cell Cancer

The condition hereditary leiomyomatosis and renal cell carcinoma is characterized by cutaneous leiomyomas, uterine fibroids and aggressive papillary renal cell carcinoma. A number of our patients with hereditary leiomyomatosis and renal cell carcinoma had atypical adrenal nodules, which were further evaluated to determine whether these nodules were associated with hereditary leiomyomatosis and renal cell carcinoma. Patients with hereditary leiomyomatosis and renal cell carcinoma underwent a comprehensive clinical and genetic evaluation. We reviewed the clinical presentation, anatomical and functional imaging, endocrine evaluation, pathological examination and germline mutation testing results. Of 255 patients with hereditary leiomyomatosis and renal cell carcinoma 20 (7.8%) had primary adrenal lesions, including 4 with bilateral adrenal lesions and 4 with multiple nodules. Two patients had adrenocorticotropic hormone independent hypercortisolism. A total of 27 adrenal lesions were evaluated. The imaging characteristics of 5 of these lesions (18.5%) were not consistent with adenoma by noncontrast computerized tomography criteria. Positron emission tomography was positive in 7 of 10 cases (70%). A total of 12 nodules were surgically resected from 10 adrenal glands. Pathological examination revealed macronodular adrenal hyperplasia in all specimens. Unilateral and bilateral adrenal nodular hyperplasia was detected in a subset of patients with hereditary leiomyomatosis and renal cell carcinoma. A functional endocrine evaluation is recommended when an adrenal lesion is discovered. Imaging frequently reveals lesions that are not typical of adenomas and positron emission tomography may be positive. To date no patient has had adrenal malignancy, and active surveillance of hereditary leiomyomatosis and renal cell carcinoma adrenal nodules appears justified.

Experiencia inicial con una serie de adrenalectomía laparoscópica asistida por robot

ObjectivesWe present our initial experience using robotic-assisted laparoscopic adrenalectomy in the surgical treatment of adrenal masses. Material and methodsA total of 18 patients (11 women and 7 men) diagnosed of a functioning or non-functioning adrenal tumor mass were operated on in our facilities between October 2009 and October 2011. Surgical variables, intra-hospital recovery time, pathological findings and peri- and post-operatory findings were evaluated. ResultsMean age of the population intervened was 51.2 years (range 18-81), average ASA score 2.11 (range 1-4) and BMI 27.0 (range 18.8-36.1). Of the 18 patients, 11 were operated on the left side and 7 on the right. Mean surgery time was 150 (range 84-329) min and intra-operatory bleeding 121 (range 10-1500) ml, with a mean loss of hemoglobin and hematocrits of 2.11g/dl and 6.33%, respectively. Two patients were converted to conventional surgery. The factors influencing surgical conversion were: normal size (>10cm), tumor weight (>100g.), active pheochromocytoma and left localization of the tumor. Seven functioning cortical adenomas, 6 metastatic adrenal tumors, 3 pheochromocytoma and 2 incidental tumors were excised. Mean tumor size was 5.39 (range 3-15) cm. Median hospital stay was 6 days (range 4-14). Five patients had peri-operatory complication. Of these, only one (5%) had major complications (Clavien III). Mean follow-up was 6 months (range 2-24). ConclusionsRobotic technology for laparoscopic adrenalectomies is a valid option for adrenal tumor treatment. In our experience with a relatively short learning curve, it makes it possible to reduce hospital treatment times and the intra- and post-operatory complications, without affecting the oncological and post-operatory functional results.

Robot-Assisted Laparoscopic Partial Adrenalectomy for Pheochromocytoma: The National Cancer Institute Technique

BackgroundPartial adrenalectomy has recently been advocated to preserve unaffected adrenal tissue during resection of pheochromocytoma. ObjectiveTo describe a robot-assisted laparoscopic partial adrenalectomy (RALPA) technique and to report on early functional and oncologic outcomes. Design, setting, and participantsFrom 2007 to 2010, 15 RALPA were performed on 12 consecutive patients with pheochromocytoma. Follow-up data of >1 yr are available on 11 procedures. Median follow-up for the entire cohort was 17.3 mo (range: 6–45). Surgical procedurePositioning and port placement is designed for adequate reach and visualization of the upper retroperitoneum. The plane between the adrenal cortex and pheochromocytoma pseudocapsule is identified visually and with laparoscopic ultrasound. The tumor is dissected away from normal adrenal cortex, preserving normal adrenal tissue. MeasurementsPreoperative, perioperative, pathologic, and functional outcomes data were analyzed. Results and limitationsFourteen of 15 cases were completed robotically. Among 15 procedures, 4 were performed on a solitary adrenal gland. Four cases required resection of multiple tumors (up to six) with two performed in a solitary gland. The mean age of the patients was 30 yr, and the mean body mass index was 27. The mean operative time was 163min, the median estimated blood loss was 161ml, and the median tumor size was 2.7cm (range: 1.3–5.5). There was one conversion to an open procedure in a patient requiring reoperation on a solitary adrenal gland. One patient who underwent RALPA on a solitary adrenal gland required postoperative steroid supplementation at last follow-up. At a median follow-up of 17.3 mo (range: 6–45), there were no recurrences or metastatic events. Study limitations include small sample size and short follow-up. ConclusionsRALPA for the treatment of pheochromocytoma is feasible and safe and provides encouraging functional and oncologic outcomes, even in patients with a solitary adrenal lesion or multiple ipsilateral lesions.

V856 ROBOT-ASSISTED LAPAROSCOPIC PARTIAL ADRENALECTOMY FOR PHEOCHROMOCYTOMA: THE NATIONAL CANCER INSTITUTE TECHNIQUE

Background: Partial adrenalectomy has recently been advocated to preserve unaffected adrenal tissue during resection of pheochromocytoma. Objective: To describe a robot-assisted laparoscopic partial adrenalectomy (RALPA) technique and to report on early functional and oncologic outcomes. Design, setting, and participants: From 2007 to 2010, 15 RALPAwere performed on 12 consecutive patients with pheochromocytoma. Follow-up data of >1 yr are available on 11 procedures. Median follow-up for the entire cohort was 17.3 mo (range: 6–45). Surgical procedure: Positioning and port placement is designed for adequate reach and visualization of the upper retroperitoneum. The plane between the adrenal cortex and pheochromocytoma pseudocapsule is identified visually and with laparoscopic ultrasound. The tumor is dissected away from normal adrenal cortex, preserving normal adrenal tissue. Measurements: Preoperative, perioperative, pathologic, and functional outcomes data were analyzed. Results and limitations: Fourteen of 15 cases were completed robotically. Among 15 procedures, 4 were performed on a solitary adrenal gland. Four cases required resection of multiple tumors (up to six) with two performed in a solitary gland. The mean age of the patients was 30 yr, and the mean body mass index was 27. The mean operative time was 163 min, the median estimated blood loss was 161 ml, and the median tumor size was 2.7 cm (range: 1.3–5.5). There was one conversion to an open procedure in a patient requiring reoperation on a solitary adrenal gland. One patient who underwent RALPA on a solitary adrenal gland required postoperative steroid supplementation at last follow-up. At a median follow-up of 17.3 mo (range: 6–45), there were no recurrences or metastatic events. Study limitations include small sample size and short follow-up. Conclusions: RALPA for the treatment of pheochromocytoma is feasible and safe and provides encouraging functional and oncologic outcomes, even in patients nal lesion or multiple ipsilateral lesions. ed by Elsevier B.V. on behalf of European Association of Urology. with a solitary adre Publish

Robot-assisted Laparoscopic Partial Adrenalectomy: Initial Experience

To evaluate the feasibility of performing robot-assisted laparoscopic partial adrenalectomy (RALPA) in patients seen at the National Cancer Institute and report the results of our initial experience. We reviewed the records of patients with adrenal masses who underwent attempted RALPA from July of 2008 until January of 2010. Demographic, perioperative, and pathologic data were collected. The functional and early oncological outcomes were examined by the need for steroid replacement and development of recurrent disease, respectively. Ten patients underwent a total of 13 attempted RALPAs for removal of 19 adrenal tumors. There was one open conversion with successful completion of partial adrenalectomy. Of the patients, 80% had a known hereditary syndrome predisposing them to adrenal tumors. One patient had bilateral multifocal adrenal masses with unknown germ line genetic alteration and 1 patient had a sporadic adrenal mass. Of the 19 tumors removed, 17 were pheochromocytoma and 2 were adrenal-cortical hyperplasia. Two patients underwent partial adrenalectomy on a solitary adrenal gland, with one subsequently requiring steroid replacement postoperatively. On postoperative imaging, all but one operated adrenal gland demonstrated contrast enhancement. No patient developed local recurrence at a median follow-up of 16.2 months (range, 2-29). RALPA appears safe and feasible in our early experience. Only 1 patient in our series required steroid replacement. Local recurrence rates are low but will require longer follow-up.

Robot-assisted laparoscopic partial adrenalectomy: a case report and review of the literature.

Adrenal-sparing surgery has recently been reported in the literature on minimally-invasive surgery. Originally described as a conventional laparoscopic procedure, encouraging outcomes in terms of preservation of adrenal function have been reported. Since the introduction of robotic surgery, surgeons have utilized robotic assistance for adrenal surgery and have recently described adrenal-sparing surgery using this platform. Certain patients that present with adrenal masses may benefit from minimally-invasive partial adrenalectomy, including those with a solitary adrenal gland, bilateral adrenal masses, and hereditary disease predisposing them to multiple adrenal masses. Patients without these conditions may also benefit from adrenal-sparing surgery in order to preserve normal adrenal function. We present the case of a patient with a 1.5-cm adrenal mass who elected to undergo adrenal-sparing surgery. The technique of transperitoneal laparoscopic partial adrenalectomy utilizing the da Vinci™ Surgical System is described. We also review the literature on minimally-invasive partial adrenalectomy in which robotic-assistance was utilized. In conclusion, while robot-assisted laparoscopic partial adrenalectomy remains in its infancy, it can be performed safely and with satisfactory surgical and functional outcomes.

ROBOTIC ASSISTED LAPAROSCOPIC ADRENALECTOMY

You have accessJournal of Urology1 Apr 2009ROBOTIC ASSISTED LAPAROSCOPIC ADRENALECTOMY Jamey A Sarvis, Penner Schraudenbach, and Dipen J Parekh Jamey A SarvisJamey A Sarvis More articles by this author , Penner SchraudenbachPenner Schraudenbach More articles by this author , and Dipen J ParekhDipen J Parekh More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(09)60526-7AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "ROBOTIC ASSISTED LAPAROSCOPIC ADRENALECTOMY." The Journal of Urology, 181(4S), p. 183 © 2009 by American Urological AssociationFiguresReferencesRelatedDetails Volume 181Issue 4SApril 2009Page: 183 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetricsAuthor Information Jamey A Sarvis More articles by this author Penner Schraudenbach More articles by this author Dipen J Parekh More articles by this author Expand All Advertisement PDF downloadLoading ...

Robot-Assisted Laparoscopic Adrenalectomy for Adrenocortical Carcinoma: Initial Report and Review of the Literature

We report the first robot-assisted laparoscopic adrenalectomy for adrenocortical carcinoma. This patient was referred to our center for extirpation of an incidentally discovered 8-cm adrenal mass. The patient underwent robot-assisted laparoscopic adrenalectomy. Surgical margins were negative for malignancy, and the patient was discharged home on the first postoperative day. We review the literature regarding robot-assisted laparoscopic adrenalectomy and discuss the potential benefits of this technique as compared with standard laparoscopy in the management of adrenocortical carcinoma.

TECHNIQUE OF LEFT ROBOT-ASSISTED LAPAROSCOPIC ADRENALECTOMY

You have accessJournal of Urology1 Apr 2008TECHNIQUE OF LEFT ROBOT-ASSISTED LAPAROSCOPIC ADRENALECTOMY Herman S Bagga, Adam Levinson, David J Hernandez, Jeffrey Piacitelli, and Li-Ming Su Herman S BaggaHerman S Bagga More articles by this author , Adam LevinsonAdam Levinson More articles by this author , David J HernandezDavid J Hernandez More articles by this author , Jeffrey PiacitelliJeffrey Piacitelli More articles by this author , and Li-Ming SuLi-Ming Su More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)62074-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "TECHNIQUE OF LEFT ROBOT-ASSISTED LAPAROSCOPIC ADRENALECTOMY." The Journal of Urology, 179(4S), pp. 711–712 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 711-712 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Herman S Bagga More articles by this author Adam Levinson More articles by this author David J Hernandez More articles by this author Jeffrey Piacitelli More articles by this author Li-Ming Su More articles by this author Expand All Advertisement PDF downloadLoading ...

Surrénalectomie cœlioscopique robotisée

Laparoscopy has emerged as the standard procedure for surgical treatment of benign adrenal diseases. These past 5 years, there have been concurrent improvements in the field of robotic surgery. Almost all urologic procedures initially performed laparoscopically have become performed with robotic assistance. Following a review of anatomic aspects, this paper discusses the indication, resumes the initial laboratory experience, and presents a description of the technique. Robot-assisted laparoscopic adrenalectomy has been performed in very few subjects worldwide. Advantages of robotic assistance over conventional laparoscopy are not acknowledged. Improvement in robotic technology, including addition of tactile feedback, miniaturization of end-effectors, reduced cost, and advances in remote surgery telecommunication technology are awaited. This will help in defining the place of robotics in treatment of adrenal diseases.

Comparison of robot-assisted laparoscopic adrenalectomy with traditional laparoscopic adrenalectomy - 1 year follow-up

Laparoscopic adrenalectomy offers distinct benefits to patients and has now become the gold standard for the removal of adrenal lesions. Nonetheless, the procedure poses a challenge for surgeons in regards to the maneuverability of instruments, the two-dimensional operating field and the counterintuitive movements. This study reports our experience using the Zeus robotic surgical system in laparoscopic adrenalectomy compared with traditional laparoscopic adrenalectomy. From January 2003 to February 2005, a total of 12 patients were prospectively enrolled to receive robot-assisted laparoscopic adrenalectomy (RALA) or traditional laparoscopic adrenalectomy (TLA). The time necessary for robotic setup and operation was recorded, as well as complications, technical problems, postoperative hospital stay, morbidity, and mortality. Five RALA procedures and seven TLA were successfully completed. There was no significant difference between the groups in terms of age, body mass index, and tumor size. Resection times were longer in the RALA group (168.0 +/- 30.7 min vs. 131.4 +/- 29.0 min, p = 0.05). There were no perioperative complications. There was neither postoperative mortality nor morbidity at the time of discharge and during one year follow-up. RALA is as safe and technically feasible as TLA, It provides a real benefit for the surgeon with the three dimensional view, a comfortable sitting position, the elimination of the surgeon's tremor, and increased degrees of freedom of the operative instruments compared with TLA. However, patient outcomes and operative costs should be evaluated further.

Robotic-assisted laparoscopic adrenalectomy

Introduction Remote robotic telemanipulators have been recently used in performing laparoscopic urologic procedures, both in the laboratory and in clinical practice. We present, to our knowledge, the initial 2 cases of robotic-assisted laparoscopic adrenalectomy in humans. Technical considerations Robotic-assisted laparoscopic adrenalectomy (one right, one left) was performed in 2 patients with an adrenal tumor (one nonfunctional, one pheochromocytoma). Patient age was 81 and 47 years, and tumor size was 4.5 and 3 cm, respectively. Both cases were performed transperitoneally using the da Vinci Robotic Surgical System. Robotic-assisted laparoscopic adrenalectomy was successful in both cases without conversion to conventional laparoscopy or open surgery. The operative time was 110 and 165 minutes, the blood loss was 50 and 100 mL, and the hospital stay was 2 and 3 days. No intraoperative or postoperative complications occurred. Conclusions Robotic-assisted laparoscopic adrenalectomy is technically feasible. With increasing experience and refinement in the technology, the role of robotics in urologic laparoscopy is likely to expand.