Robot assisted laparoscopic adrenalectomy: Should this be the new standard?

Introduction: Minimal invasive surgeries (MIS) for large size adrenal tumors are still debatable. The objective is to evaluate the contemporary peri- and post-operative outcomes of patients undergoing (open = OA, laparoscopic = LA, and robotic = RA) adrenalectomies in three institutions.

Materials And Methods: Retrospectively gathered peri- and post-operative data of 235 patients, underwent adrenalectomy at three Institutions over a 7-year period (2013-2020) were analyzed. All patients underwent thorough radiological and endocrine workup.

Results: Two hundred and thirty five patients who underwent adrenalectomy (OA ( = 29), LA ( = 146), and RA ( = 60)) were assessed. OA ( = 29) versus Minimally invasive surgery ( = 206) showed significant differences (median, value) in larger tumour size, cm (9.4 vs 5, ( = 0.0001)), longer operative time, mins (240 vs 100, ( = 0.0001)), longer hospital stay, days (8 vs 3,( = .0001)), Higher readmission rates (14% vs 1.9%), higher blood loss, ml (400 vs 100, ( = 0.0001)) requiring blood transfusion (14% vs 4.3%) ( = 0.03), higher intraoperative complication (21% vs 6%) ( = 0.0004), and post op complications (17% vs 5.3%) ( = 0.01). Amongst the MIS (RA vs LA), RA appeared be have better outcomes in terms of shorter operative time, less blood loss and less intra operative complications with a value <0.05. These results were consistent for the assessment of patients who had ⩾6 cm tumor size. The postoperative complication rates were lowest with RA (3.3%) compared to OA (17%) and LA (6.1%).

Conclusions: Contemporary practice of adrenalectomy shows that robotic adrenalectomy is safe and effective irrespective of the tumor size.