Ann Surg Treat Res.  2023 Aug;105(2):69-75. 10.4174/astr.2023.105.2.69.

Comparison of robotic and laparoscopic lateral transperitoneal adrenalectomies

• Ko SY
• Chang YW
• Ku D
• Yu DY
• Lee HY
• Ji WB
• Son GS

• KMID: 2545157
• DOI: http://doi.org/10.4174/astr.2023.105.2.69

Abstract

Purpose
This study aimed to compare the intraoperative and postoperative outcomes between robotic and laparoscopic transperitoneal adrenalectomies.
Methods
In this retrospective study, 93 patients underwent adrenalectomy using 2 surgical modalities: 45 patients underwent adrenalectomy using the da Vinci Xi system (robotic group), and 48 patients using laparoscopic devices (laparoscopic group). We compared the operation time, intraoperative bleeding, and hospital stay according to the surgical modality and tumor characteristics.
Results
There were no significant differences in the operative time (P = 0.827), hospital stay (P = 0.177), and intraoperative bleeding (P = 0.174) between the groups. However, the robotic group showed a lower coefficient of variation in total operative time than that of the laparoscopic group (100.6 ± 23.3 minutes vs. 101.9±32.7 minutes, 0.230 vs. 0.321). When divided into 2 subgroups based on the tumor size (<3 cm and ≥3 cm), the robotic group with a tumor sized >3 cm had a shorter operative time than that of the laparoscopic group (P = 0.032). The robotic group also had fewer cases of intraoperative bleeding (P = 0.034).
Conclusions
Compared to the laparoscopic transperitoneal adrenalectomy, the robotic one achieved a lower deviation in total operative time and showed less bleeding and a shorter operative time, especially for tumors sized >3 cm.

Keyword

Adrenalectomy; Cushing syndrome; Hyperaldosteronism; Pheochromocytoma; Robot surgical procedures

Figure

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  Fig. 1 Flow chart of the study population.

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  Fig. 2 (A) A photo showing the left lateral decubitus position and port placement for right adrenalectomy, (B) A photo showing the right lateral decubitus position and port placement for left adrenalectomy, (C) A photo showing the camera port replacement through the glove port in robotic adrenalectomy. Blue circles, 8 mm trocars for robotic devices; blue triangle, 8-mm trocar for a robotic camera; red circles, 5-mm trocars for left-handed laparoscopic device and liver-retractor; red triangle, 12-mm trocar for the laparoscopic camera; red square, right-handed laparoscopic device. Written informed consent was obtained from the patients for the publication of clinical images.

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  Fig. 3 Liver retraction (A) using a robotic device by a surgeon itself in robotic adrenalectomy, (B) using retractor by an assistant in laparoscopic adrenalectomy.

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  Fig. 4 (A) The duration, (B) average, and standard deviation of total operative time; the mean time of total operative time is not statistically different in both groups (100.6 ± 23.3 minutes vs. 101.9 ± 32.7 minutes, p = 0.827), but the coefficient of variation of time is lower in the robotic group than in the laparoscopic group (0.230 vs. 0.321).

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