Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct;10(4):475-481.
doi: 10.1016/j.ajur.2023.04.001. Epub 2023 Jun 15.

Robot-assisted adrenalectomy: Step-by-step technique and surgical outcomes at a high-volume robotic center

Federico Piramide  1   2   3 , Carlo Andrea Bravi  1   2 , Marco Paciotti  1   2   4 , Luca Sarchi  1   2   5 , Luigi Nocera  1   2   6 , Adele Piro  1   2   7 , Maria Peraire Lores  1   2 , Eleonora Balestrazzi  1   2   8 , Angelo Mottaran  1   2   8 , Rui Farinha  2 , Hubert Nicolas  9 , Pieter De Backer  2 , Frederiek D'hondt  1 , Peter Schatteman  1 , Ruben De Groote  1 , Geert De Naeyer  1 , Alexandre Mottrie  1   2
Affiliations

Robot-assisted adrenalectomy: Step-by-step technique and surgical outcomes at a high-volume robotic center

Federico Piramide et al. Asian J Urol. 2023 Oct.

Abstract

Objective: In the last years, robotic surgery was introduced in several different settings with good perioperative results. However, its role in the management of adrenal masses is still debated. In order to provide a contribution to this field, we described our step-by-step technique for robotic adrenalectomy (RA) and related modifications according to the type of adrenal mass treated.

Methods: We retrospectively analyzed 27 consecutive patients who underwent RA at Onze-Lieve-Vrouw hospital (Aalst, Belgium) between January 2009 and October 2022. Demographic, intra- and post-operative, and pathological data were retrieved from our prospectively maintained institutional database. Continuous variables are summarized as median and interquartile range (IQR). Categorical variables are reported as frequencies (percentages).

Results: Twenty-seven patients underwent RA were included in the study. Median age, body mass index, and Charlson's comorbidity index were 61 (IQR: 49-71) years, 26 (IQR: 24-29) kg/m2, and 2 (IQR: 0-3), respectively, and 16 (59.3%) patients were male. Median tumor size at computed tomography scan was 6.0 (IQR: 3.5-8.0) cm. Median operative time and blood loss were 105 (IQR: 82-120) min and 175 (IQR: 94-250) mL, respectively. No intraoperative complications were recorded. Overall postoperative complications rate was 11.1%, with a postoperative transfusion rate of 3.7%. A total of 10 (37.0%) patients harbored malignant adrenal masses. Among them, 3 (11.1%) had adrenocortical carcinoma, 6 (22.2%) secondary metastasis, and 1 (3.7%) malignant pheochromocytoma on final pathological exam. Only 1 (10.0%) patient had positive surgical margins.

Conclusion: We described our step-by-step technique for RA, which can be safely performed even in case of high challenging settings as malignant tumors, pheochromocytoma, and large masses. The standardization of perioperative protocol should be encouraged to maximize the outcomes of this complex surgical procedure.

Keywords: Adrenalectomy; Malignant; Pheochromocytoma; Robotics; Surgical technique.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Left side trocars placement. For right side procedure, the trocars were placed in a mirror fashion.
Figure 2
Figure 2
Identification of right renal vein and inferior vena cava during right adrenalectomy.
Figure 3
Figure 3
Clipping of right adrenal vein.
Figure 4
Figure 4
Development of posterior plane. During this phase, the arterial pedicles were identified and clipped.
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. doi: 10.1056/NEJM199210013271417. - DOI - PubMed
    1. Fassnacht M., Arlt W., Bancos I., Dralle H., Newell-Price J., Sahdev A., et al. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice guideline in collaboration with the European network for the study of adrenal tumors. Eur J Endocrinol. 2016;175:G1–G34. doi: 10.1530/EJE-16-0467. - DOI - PubMed
    1. Agrusa A., Romano G., Navarra G., Conzo G., Pantuso G., Di Buono G., et al. Innovation in endocrine surgery: robotic versus laparoscopic adrenalectomy. Meta-analysis and systematic literature review. Oncotarget. 2017;8:102392–102400. - PMC - PubMed
    1. Conzo G., Tartaglia E., Gambardella C., Esposito D., Sciascia V., Mauriello C., et al. Minimally invasive approach for adrenal lesions: systematic review of laparoscopic versus retroperitoneoscopic adrenalectomy and assessment of risk factors for complications. Int J Surg. 2016;28(Suppl 1):S118–S123. doi: 10.1016/j.ijsu.2015.12.042. - DOI - PubMed
    1. Araujo-Castro M., Garcia Centeno R., López-García M.C., Lamas C., Álvarez-Escolá C., Calatayud Gutiérrez M., et al. Risk factors for intraoperative complications in pheochromocytomas. Endocr Relat Cancer. 2021;28:695–703. - PubMed

LinkOut - more resources