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. 2022 Nov;36(11):8619-8629.
doi: 10.1007/s00464-022-09663-3. Epub 2022 Oct 3.

Robot-assisted vs laparoscopic lateral transabdominal adrenalectomy: a propensity score matching analysis

Carmela De Crea  1   2 , Francesco Pennestrì  3   4 , Nikolaos Voloudakis  1 , Luca Sessa  2   5 , Priscilla Francesca Procopio  1   2 , Pierpaolo Gallucci  1 , Rocco Bellantone  1   2 , Marco Raffaelli  1   2
Affiliations

Robot-assisted vs laparoscopic lateral transabdominal adrenalectomy: a propensity score matching analysis

Carmela De Crea et al. Surg Endosc. 2022 Nov.

Abstract

Background: Laparoscopic adrenalectomy (LA) is the gold standard treatment for adrenal lesions. Robot-assisted adrenalectomy (RAA) is a safe approach, associated with higher costs in absence of clear-cut benefits. Several series reported some advantages of RAA over LA in challenging cases, but definitive conclusions are lacking. We evaluated the cost effectiveness and outcomes of robotic (R-LTA) and laparoscopic (L-LTA) approach for lateral transabdominal adrenalectomy in a high-volume center.

Methods: Among 356 minimally invasive adrenalectomies (January 2012-August 2021), 286 were performed with a lateral transabdominal approach: 191 L-LTA and 95 R-LTA. The R-LTA and L-LTA patients were matched for lesion side and size, hormone secretion, and BMI with propensity score matching (PSM) analysis. Postoperative complications, operative time (OT), postoperative stay (POS), and costs were compared.

Results: PSM analysis identified 184 patients, 92 in R-LTA and 92 in L-LTA group. The two groups were well matched. The median lesion size was 4 cm in both groups (p = 0.533). Hormonal hypersecretion was detected in 55 and 54 patients of R-LTA and L-LTA group, respectively (p = 1). Median OT was significantly longer in R-LTA group (90.0 vs 65.0 min) (p < 0.001). No conversion was registered. Median POS was similar (4.0 vs 3.0 days in the R-LTA and L-LTA) (p = 0.467). No difference in postoperative complications was found (p = 1). The cost margin analysis showed a positive income for both procedures (3137 vs 3968 € for R-LTA and L-LTA). In the multiple logistic regression analysis, independent risk factors for postoperative complications were hypercortisolism (OR = 3.926, p = 0.049) and OT > 75 min (OR = 8.177, p = 0.048).

Conclusions: The postoperative outcomes of R-LTA and L-TLA were similar in our experience. Despite the higher cost, RAA appears to be cost effective and economically sustainable in a high-volume center (60 adrenalectomies/year), especially if performed in challenging cases, including patients with large (> 6 cm) and/or functioning tumors.

Keywords: Laparoscopic adrenalectomy; Lateral transabdominal adrenalectomy; Outcomes; Postoperative complications; Robot-assisted adrenalectomy.

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Conflict of interest statement

Drs. Francesco Pennestrì, Nikolaos Voloudakis, Luca Sessa, Priscilla Francesca Procopio, Pierpaolo Gallucci, and Professors Carmela De Crea, Rocco Bellantone, Marco Raffaelli have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Study patients’ flowchart diagram
See this image and copyright information in PMC

References

    1. Gagner M, Lacroix A, Bolté E. Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med. 1992;327:1033–1033. doi: 10.1056/NEJM199210013271417. - DOI - PubMed
    1. Gagner M, Lacroix A, Bolte E, Pomp A. Laparoscopic adrenalectomy. the importance of a flank approach in the lateral decubitus position. Surg Endosc. 1994;8:135–138. doi: 10.1007/BF00316627. - DOI - PubMed
    1. Marescaux J, Mutter D, Wheeler MH. Laparoscopic right and left adrenalectomies: surgical procedures. Surg Endosc. 1996;10:912–915. doi: 10.1007/BF00188482. - DOI - PubMed
    1. Smith CD, Weber CJ, Amerson JR. Laparoscopic adrenalectomy: new gold standard. World J Surg. 1999;23:389–396. doi: 10.1007/PL00012314. - DOI - PubMed
    1. Assalia A, Gagner M. Laparoscopic adrenalectomy. Br J Surg. 2004;91:1259–1274. doi: 10.1002/bjs.4738. - DOI - PubMed

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