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Perioperative outcomes of robotic and laparoscopic adrenalectomy: a large international multicenter experience

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Abstract

Background

The aim of the study was to describe the surgical outcomes of a retrospective series of consecutive patients treated with laparoscopic and robotic approach for adrenal masses in two tertiary referral centers.

Methods

We retrospectively gathered data of 477 patients submitted to adrenalectomy performed at two Institutions from March 2008 to February 2018 by six highly experienced surgeons. We excluded from the analysis 43 patients that had an open approach for tumors or for anesthetic contraindications to minimally invasive surgery (MIS). Patients were selected for surgery after a radiologic and an endocrinology work up. Preoperative, perioperative and postoperative data were recorded.

Results

Overall, 477 patients were included in the study. The robotic and the laparoscopic group included 110 and 367 patients, respectively. The preoperative characteristics were similar in both groups except for ASA score with a median (IQR) of 3 and 2 in the robotic and in the laparoscopic group, respectively (p = 0.03). Tumor size of adrenal tumors treated robotically (4, IQR 2.6–6 cm) was significantly larger than those treated laparoscopically (3, IQR 2.3–4.1 cm) (p = 0.01). The intraoperative complication rates were similar between robotic and laparoscopic groups (6.3% and 6%, respectively). The postoperative complication rate was 5.4% for robotic group and similarly 3.5% for laparoscopic adrenalectomy strategy. We analyzed the tumor ≥ 6 cm, with 29 patients in the robotic group and 43 in the laparoscopic one, with an overall complication rate of 19.5%. At multivariable analyses tumor size (OR 1.287; CI 1.128–1.468; p < 0.001) was the only independent predictor of overall complication.

Conclusion

Adrenal tumors can be safely treated either by robotic or laparoscopic strategy. MIS seems to be feasible also in larger adrenal masses (≥ 6 cm). Tumor size represents the only predictive factors for overall complication.

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Authors and Affiliations

  1. Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, San Luca Nuovo, Largo Brambilla 3, 50134, Florence, Italy

    Simone Sforza, Andrea Minervini, Riccardo Tellini, Fabrizio Di Maida, Lorenzo Masieri & Marco Carini

  2. Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China

    Changwei Ji, Qun Lu, Wei Chen, Feifei Zhang, Hao Ji & Hongqian Guo

  3. Institute of Urology, Nanjing University, Nanjing, China

    Changwei Ji, Qun Lu, Wei Chen, Feifei Zhang, Hao Ji & Hongqian Guo

  4. Emergency Surgery Unit, Careggi Hospital, Florence, Italy

    Carlo Bergamini, Alessio Giordano, Paolo Prosperi & Andrea Valeri

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  1. Simone Sforza
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  2. Andrea Minervini
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  3. Riccardo Tellini
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  4. Changwei Ji
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  5. Carlo Bergamini
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  7. Qun Lu
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  8. Wei Chen
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  13. Lorenzo Masieri
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  14. Marco Carini
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  15. Andrea Valeri
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  16. Hongqian Guo
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Corresponding author

Correspondence to Simone Sforza.

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Disclosures

Simone Sforza, Andrea Minervini, Riccardo Tellini, Changwei Ji, Carlo Bergamini, Alessio Giordano, Qun Lu, Wei Chen, Feifei Zhang, Hao Ji, Fabrizio Di Maida, Paolo Prosperi, Lorenzo Masieri, Marco Carini, Andrea Valeri and Hongqian Guo have no conflicts of interest or financial ties to disclose.

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Sforza, S., Minervini, A., Tellini, R. et al. Perioperative outcomes of robotic and laparoscopic adrenalectomy: a large international multicenter experience. Surg Endosc 35, 1801–1807 (2021). https://doi.org/10.1007/s00464-020-07578-5

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