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

doi:10.1016/j.ajur.2023.04.001

Asian Journal of Urology, 2023, 10 (4): 475-481 doi: 10.1016/j.ajur.2023.04.001

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

Federico Piramide^a,b,c,*(

),Carlo Andrea Bravi^a,b,Marco Paciotti^a,b,d,Luca Sarchi^a,b,e,Luigi Nocera^a,b,f,Adele Piro^a,b,g,Maria Peraire Lores^a,b,Eleonora Balestrazzi^a,b,h,Angelo Mottaran^a,b,h,Rui Farinha^b,Hubert Nicolasⁱ,Pieter De Backer^b,Frederiek D'hondt^a,Peter Schatteman^a,Ruben De Groote^a,Geert De Naeyer^a,Alexandre Mottrie^a,b

^aDepartment of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
^bORSI Academy, Ghent, Belgium
^cDepartment of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
^dDepartment of Urology, Humanitas Research Hospital- IRCCS, Rozzano, Italy
^eDepartment of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
^fUnit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
^gDepartment of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
^hDivision of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
ⁱUrological Department, La Citadelle, Liège, Belgium

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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.

Key words： Robotics Adrenalectomy Pheochromocytoma Malignant Surgical technique

Received: 24 December 2022 Available online: 20 October 2023

Corresponding Authors: *Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium. E-mail address: federico.piramide@gmail.com (F. Piramide).

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	Federico Piramide
	Carlo Andrea Bravi
	Marco Paciotti
	Luca Sarchi
	Luigi Nocera
	Adele Piro
	Maria Peraire Lores
	Eleonora Balestrazzi
	Angelo Mottaran
	Rui Farinha
	Hubert Nicolas
	Pieter De Backer
	Frederiek D'hondt
	Peter Schatteman
	Ruben De Groote
	Geert De Naeyer
	Alexandre Mottrie

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Cite this article:

Federico Piramide,Carlo Andrea Bravi,Marco Paciotti, et al. Robot-assisted adrenalectomy: Step-by-step technique and surgical outcomes at a high-volume robotic center[J]. Asian Journal of Urology, 2023, 10(4): 475-481.

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http://www.ajurology.com/EN/10.1016/j.ajur.2023.04.001 OR http://www.ajurology.com/EN/Y2023/V10/I4/475

Left side trocars placement. For right side procedure, the trocars were placed in a mirror fashion.

Identification of right renal vein and inferior vena cava during right adrenalectomy.

Clipping of right adrenal vein.

Development of posterior plane. During this phase, the arterial pedicles were identified and clipped.

Demographic variables.

Surgical variables.

Pathological variables.

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