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Robotic-assisted unilateral adrenalectomy: risk factors for perioperative complications in 303 consecutive patients

  • Tristan Greilsamer
  • Claire Nomine-Criqui
  • Michaël Thy
  • Timothy Ullmann
  • Rasa Zarnegar
  • Laurent Bresler
  • Laurent Brunaud
Article
  • 6 Downloads

Abstract

Background

There is no consensus about the utility of using the robotic platform to perform a unilateral lateral transabdominal adrenalectomy in comparison with conventional laparoscopy. In some groups, obese patients (Body Mass Index > 30 kg/m2) and patients with tumor size > 5 cm have been considered as good candidates for robotic adrenalectomy. However, evaluation of incidence and risk factors for perioperative complications is currently lacking in large series of patients. The aim of this study was to evaluate incidence and predictive factors for intraoperative (conversion and capsular rupture) and postoperative complications (morbidity) after unilateral robotic-assisted transabdominal lateral adrenalectomy.

Methods

From 2001 to 2016, consecutive patients undergoing unilateral lateral transabdominal robotic adrenalectomy were included in a prospectively maintained database and analyzed retrospectively (clinicaltrials.gov NCT03410394).

Results

A total of 303 consecutive patients were analyzed. Between the first and last 100 of patients, mean tumor size increased from 2.9 to 4.2 cm (p < 0.001) and mean operating time decreased from 99 to 77 min (p < 0.001). Postoperative complications occurred in 28 patients (9.2%) and no postoperative death was observed. Nine patients (3%) were converted to open laparotomy and capsular rupture was observed in nine patients (3%). BMI was not a significant risk factor for conversion, capsular rupture, or postoperative complication. Tumor size > 5 cm remained the only predictive factor for conversion to laparotomy (OR 7.47, 95% CI 1.81–30.75; p = 0.005). History of upper gastrointestinal surgery was the only predictive factor for capsular rupture (OR 13.6, 95% CI 2.33–80.03; p = 0.004). Conversion to laparotomy (OR 8.35, 95% CI 1.99–35.05; p = 0.003) and patient age (OR 1.039, 95% CI 1.006–1.072; p = 0.019) remained independent predictive factors for postoperative complications.

Conclusions

This study identified independent risk factors for perioperative complications after robotic-assisted unilateral adrenalectomy. These factors should be taken into account when evaluating robotic-assisted transabdominal lateral adrenalectomy.

Keywords

Robotics Adrenalectomy Transabdominal Laparoscopy Complications 

Notes

Compliance with ethical standards

Disclosures

Laurent Bresler is proctor for Intuitive Surgical Inc (pelvic floor procedures). Tristan Greilsamer, Claire Nomine-Criqui, Michaël Thy, Timothy Ullmann, Rasa Zarnegar, and Laurent Brunaud declare that they have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Centre Hospitalier Universitaire (CHU) Nantes-Hôtel Dieu, Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Institut des Maladies del’Appareil Digestif (IMAD)NantesFrance
  2. 2.Université de Lorraine, Service de Chirurgie Digestive, Hépatobiliaire, Pancréatique, Endocrinienne et Cancérologique, Centre Hospitalier Régional Universitaire (CHRU) Nancy-BraboisVandoeuvre-Les-NancyFrance
  3. 3.Hôpitaux Universitaires Paris Nord Val-de-Seine, Service d’Anesthésie et de Réanimation Chirurgicale, Hôpital Bichat-Claude BernardParisFrance
  4. 4.Department of Surgery, Weill Cornell Medical CenterNew York Presbyterian HospitalNew YorkUSA
  5. 5.Faculty of MedicineUniversité de Lorraine, University de Lorraine, INSERM U954NancyFrance

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