Surgical Endoscopy

, Volume 33, Issue 3, pp 802–810 | Cite as

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 BrunaudEmail author



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.


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


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.


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.


Robotics Adrenalectomy Transabdominal Laparoscopy Complications 


Compliance with ethical standards


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.


  1. 1.
    Bittner JG, Gershuni VM, Matthews BD, Moley JF, Brunt LM (2013) Risk factors affecting operative approach, conversion, and morbidity for adrenalectomy: a single-institution series of 402 patients. Surg Endosc 27:2342–2350CrossRefGoogle Scholar
  2. 2.
    Coste T, Caiazzo R, Torres F, Vantyghem MC, Carnaille B, Pattou F et al (2017) Laparoscopic adrenalectomy by transabdominal lateral approach: 20 years of experience. Surg Endosc 31:2743–2751CrossRefGoogle Scholar
  3. 3.
    Gaujoux S, Bonnet S, Leconte M, Zohar S, Bertherat J, Bertagna X et al (2011) Risk factors for conversion and complications after unilateral laparoscopic adrenalectomy. Br J Surg 98:1392–1399CrossRefGoogle Scholar
  4. 4.
    Hattori S, Miyajima A, Maeda T, Hasegawa M, Takeda T, Kosaka T et al (2012) Risk factors for perioperative complications of laparoscopic adrenalectomy including single-site surgery. J Endourol 26:1463–1467CrossRefGoogle Scholar
  5. 5.
    Shen WT, Sturgeon C, Duh QY (2005) From incidentaloma to adrenocortical carcinoma: the surgical management of adrenal tumors. J Surg Oncol 89:186–192CrossRefGoogle Scholar
  6. 6.
    Aksoy E, Taskin H, Aliyev S, Mitchell J, Siperstein A, Berber E (2013) Robotic versus laparoscopic adrenalectomy in obese patients. Surg Endosc 27:1233–1236CrossRefGoogle Scholar
  7. 7.
    Brandao LF, Autorino R, Laydner H, Haber GP, Ouzaid I, De Sio M et al (2014) Robotic versus laparoscopic adrenalectomy: a systematic review and meta-analysis. Eur Urol 65:1154–1161CrossRefGoogle Scholar
  8. 8.
    Brunaud L, Ayav A, Zarnegar R, Rouers A, Klein M, Boissel P, Bresler L (2008) Prospective evaluation of 100 robotic-assisted unilateral adrenalectomies. Surgery 144:995–1001CrossRefGoogle Scholar
  9. 9.
    Morelli L, Tartaglia D, Bronzoni J, Palmeri M, Guadagni S, Di Franco G et al (2016) Robotic assisted versus pure laparoscopic surgery of the adrenal glands: a case-control study comparing surgical techniques. Langenbecks Arch Surg 401:999–1006CrossRefGoogle Scholar
  10. 10.
    Tang K, Li H, Xia D, Yu G, Guo X, Guan W, Xu H, Ye Z (2015) Robot-assisted versus laparoscopic adrenalectomy: a systematic review and meta-analysis. Surg Laparosc Endosc Percutan Tech 25:187 – 95Google Scholar
  11. 11.
    Economopoulos KP, Mylonas K, Stamou AA, Theocharidis V, Sergentanis TN, Psaltopoulou T, Richards ML (2017) Laparoscopic versus robotic adrenalectomy: a comprehensive meta-analysis. Int J Surg 38:95–104CrossRefGoogle Scholar
  12. 12.
    Brunaud L, Bresler L, Ayav A, Zarnegar R, Raphoz AL, Levan T, Weryha G, Boissel P (2008) Robotic-assisted adrenalectomy: what advantages compared to lateral transperitoneal laparoscopic adrenalectomy? Am J Surg 195:433–438CrossRefGoogle Scholar
  13. 13.
    Zografos GN, Farfaras A, Vasiliadis G, Pappa T, Aggeli C, Vassilatou E, Kaltsas G, Piaditis G (2010) Laparoscopic resection of large adrenal tumors. JSLS 14:364–368CrossRefGoogle Scholar
  14. 14.
    Societe francaise d’anesthesie et de réanimation (SFAR) (2011) Antibioprophylaxis in surgery and interventional medicine (adult patients). Ann Fr Anesth Reanim 30:168–190CrossRefGoogle Scholar
  15. 15.
    Nomine-Criqui C, Brunaud L, Germain A, Klein M, Cuny T, Ayav A, Bresler L (2015) Robotic lateral transabdominal adrenalectomy. J Surg Oncol 112:305–309CrossRefGoogle Scholar
  16. 16.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefGoogle Scholar
  17. 17.
    Kahramangil B, Berber E (2017) Comparison of posterior retroperitoneal and transabdominal lateral approaches in robotic adrenalectomy: an analysis of 200 cases. Surg Endosc. Google Scholar
  18. 18.
    Wang TS, Duh QY (2018) Volume-outcome relationship in adrenal surgery. Surgery 163:165–166CrossRefGoogle Scholar
  19. 19.
    McCulloch P, Altman DG, Campbell WB, Flum DR, Glasziou P, Marshall JC et al (2009) No surgical innovation without evaluation: the IDEAL recommendations. Lancet 374:1105–1112CrossRefGoogle Scholar
  20. 20.
    Giulianotti PC, Buchs NC, Addeo P, Bianco FM, Ayloo SM, Caravaglios G, Coratti A (2011) Robot-assisted adrenalectomy: a technical option for the surgeon? Int J Med Robot 7:27–32CrossRefGoogle Scholar
  21. 21.
    Lee CW, Salem AI, Schneider DF, Leverson GE, Tran TB, Poultsides GA et al (2017) Minimally invasive resection of adrenocortical carcinoma: a Multi-Institutional Study of 201 patients. J Gastrointest Surg 21:352–362CrossRefGoogle Scholar
  22. 22.
    Morris L, Ituarte P, Zarnegar R, Duh QY, Ahmed L, Lee J, Inabnet W 3rd, Meyer-Rochow G, Sidhu S, Sywak M, Yeh M (2008) Laparoscopic adrenalectomy after prior abdominal surgery. World J Surg 32:897–903CrossRefGoogle Scholar
  23. 23.
    Gaujoux S, Mihai R, Joint Working Group of ESES and ENSAT (2017) European Society of Endocrine Surgeons (ESES) and European Network for the Study of Adrenal Tumours (ENSAT) recommendations for the surgical management of adrenocortical carcinoma. Br J Surg 104:358–376CrossRefGoogle Scholar
  24. 24.
    Li ML, Fitzgerald PA, Price DC, Norton JA (2001) Iatrogenic pheochromocytomatosis: a previously unreported result of laparoscopic adrenalectomy. Surgery 130:1072–1077CrossRefGoogle Scholar
  25. 25.
    Lairmore TC, Folek J, Govednik CM, Snyder SK (2016) Improving minimally invasive adrenalectomy: selection of optimal approach and comparison of outcomes. World J Surg 40:1625–1631CrossRefGoogle Scholar
  26. 26.
    Maker AV, Maker VK (2017) Techniques to perform robotic left adrenalectomy in the obese patient. Surg Endosc 31:950–951CrossRefGoogle Scholar
  27. 27.
    Morino M, Beninca G, Giraudo G, Del Genio GM, Rebecchi F, Garrone C (2004) Robot-assisted vs laparoscopic adrenalectomy: a prospective randomized controlled trial. Surg Endosc 18:1742–1746CrossRefGoogle Scholar
  28. 28.
    Brunaud L (2013) Should all new surgical procedures be published ? J Visc Surg 150:163–164CrossRefGoogle Scholar

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

Personalised recommendations