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Laparoscopic versus robotic adrenalectomy in severely obese patients

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Abstract

Background

Over the last 20 years, the prevalence of severe obesity (body mass index ≥ 35 kg/m2) has almost doubled. This condition increases the challenge of laparoscopic adrenalectomy (LA) by creating problems with instrument reach, adequate exposure, and visualization. The aim was to compare perioperative outcomes of laparoscopic versus robotic adrenalectomy (RA) in severely obese patients.

Methods

This was an institutional review board-approved retrospective study. Prospectively collected clinical parameters of patients who underwent LA versus RA between 2000 and 2021 at a single center were compared using Mann–Whitney U, ANOVA, Chi-square, and multivariate regression analysis. Continuous data are expressed as median (interquartile range).

Results

For lateral transabdominal (LT) adrenalectomies, skin-to-skin operative time (OT) [164.5 (71.0) vs 198.8 (117.0) minutes, p = 0.006] and estimated blood loss [26.2 (15.0) vs 72.6 (50.0) ml, p = 0.010] were less in RA versus LA group, respectively. Positive margin rate, hospital stay and 90-day morbidity were similar between the groups (p = NS). For posterior retroperitoneal (PR) approach, operative time and perioperative outcomes were similar between LA and RA groups. Multivariate analysis demonstrated robotic versus laparoscopic technique (p = 0.006) to be an independent predictor of a shorter OT.

Conclusion

There was a benefit of robotic over the laparoscopic LT adrenalectomy regarding OT and estimated blood loss. Although limited by the small sample size, there was no difference regarding perioperative outcomes between RA and LA performed through a PR approach.

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Authors and Affiliations

  1. Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA

    Gizem Isiktas, Seyma Nazli Avci, Ozgun Erten, Onuralp Ergun, Vikram Krishnamurthy, Joyce Shin, Allan Siperstein & Eren Berber

  2. Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA

    Eren Berber

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  1. Gizem Isiktas
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  2. Seyma Nazli Avci
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Correspondence to Eren Berber.

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Disclosure

Dr. Eren Berber has unrelated consulting agreements with Ethicon, Aesculap, and Medtronics and has received honoraria for consulting work. Drs. Gizem Isiktas, Seyma Nazli Avci, Ozgun Erten, Vikram Krishnamurthy, Judy Jin, and Allan Siperstein have no conflict of interest or financial ties to disclose.

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Isiktas, G., Avci, S.N., Erten, O. et al. Laparoscopic versus robotic adrenalectomy in severely obese patients. Surg Endosc 37, 1107–1113 (2023). https://doi.org/10.1007/s00464-022-09594-z

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