Abstract
Background
Recently, we demonstrated better perioperative outcomes with robotic versus laparoscopic adrenalectomy (LA) with the posterior retroperitoneal approach in general, and for removal of large adrenal tumors. It is unknown if robotic adrenalectomy (RA) is equivalent to LA in obese patients. The aim of this study is to compare perioperative outcomes of RA versus LA in obese patients.
Methods
Between 2003 and 2012, 99 obese (BMI ≥ 30 kg/m2) patients underwent adrenalectomy at a tertiary academic center. Of these, 42 patients had RA and 57 had LA. The perioperative outcomes of these patients were compared between the RA and LA groups. Data were collected from a prospectively maintained, institutional review board approved database. Clinical and perioperative parameters were analyzed using Student t and χ2 tests. All data are expressed as mean ± standard error of the mean.
Results
The groups were similar in terms of age, gender, and tumor side. Body mass index was lower in the robotic versus laparoscopic group (35.4 ± 1.0 vs. 38.8 ± 0.8 kg/m2, respectively, p = 0.01). Tumor size (4.0 ± 0.4 vs. 4.3 ± 0.3 cm, respectively, p = 0.56), skin-to-skin operative time (186.1 ± 12.1 vs. 187.3 ± 11 min, respectively, p = 0.94), estimated blood loss (50.3 ± 24.3 vs. 76.6 ± 21.3 ml, respectively, p = 0.42), and hospital stay (1.3 ± 0.1 vs. 1.6 ± 0.1 days, respectively, p = 0.06) were similar in both groups. The conversion to open rate was zero in the robotic and 5.2 % in the laparoscopic group (p = 0.06). The 30-day morbidity was 4.8 % in the robotic and 7 % in the laparoscopic group (p = 0.63).
Conclusions
Our study did not show any difference in perioperative outcomes between RA and LA in obese patients. These results suggest that the difficulties in maintaining exposure and dissection in obese patients nullify the advantages of robotic articulating versus rigid laparoscopic instruments in adrenal surgery.
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References
Morris LF, Perrier ND (2012) Advances in robotic adrenalectomy. Curr Opin Oncol 24(1):1–6
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(1):27–32
Agcaoglu O, Aliyev S, Karabulut K, Siperstein A, Berber E (2012) Robotic vs laparoscopic posterior retroperitoneal adrenalectomy. Arch Surg 147(3):272–275
Agcaoglu O, Aliyev S, Karabulut K, Mitchell J, Siperstein A, Berber E (2012) Robotic Versus laparoscopic resection of large adrenal tumors. Ann Surg Oncol 19(7):2288–2294. doi:10.1245/s10434-012-2296-4
Ogden CL, Carroll ME, Kit BK, Flegal KM (2012) Prevalence of obesity in the United States, 2009–2010. NCHS Data Brief 82:1–8
Berber E, Tellioglu G, Harvey A, Mitchell J, Milas M, Siperstein A (2009) Comparison of laparoscopic transabdominal lateral versus posterior retroperitoneal adrenalectomy. Surgery 146(4):621–625 discussion 625–626
Berber E, Mitchell J, Milas M, Siperstein A (2010) Robotic posterior retroperitoneal adrenalectomy: operative technique. Arch Surg 145(8):781–784
Shen ZJ, Chen SW, Wang S, ** XD, Chen J, Zhu Y, Zhang RM (2007) Predictive factors for open conversion of laparoscopic adrenalectomy: a 13-year review of 456 cases. J Endourol 21(11):1333–1337
Fazeli-Matin S, Gill IS, Hsu TH, Sung GT, Novick AC (1999) Laparoscopic renal and adrenal surgery in obese patients: comparison to open surgery. J Urol 162(3 Pt 1):665–669
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(4):433–438
Morino M, Benincà G, Giraudo G, Del Genio GM, Rebecchi F, Garrone C (2004) Robot-assisted vs laparoscopic adrenalectomy: a prospective randomized controlled trial. Surg Endosc 18(12):1742–1746
Nordenstrom E, Westerdahl J, Hallgrimsson P, Bergenfelz A (2011) A prospective study of 100 robotically assisted laparoscopic adrenalectomies. Journal of Robotic Surg 5:127–131
Winter JM, Talamini MA, Stanfield CL et al (2006) Thirty robotic adrenalectomies: a single institution’s experience. Surg Endosc 20(1):119–124
Brunaud L, Germain A, Zarnegar R, Cuny T, Ayav A, Bresler L (2011) Robot-assisted adrenalectomy. Surg Laparosc Endosc Percutan Tech 21(4):248–254
Disclosures
Authors Erol Aksoy, Halit Eren Taskin, Shamil Aliyev, Jamie Mitchell, Allan Siperstein, and Eren Berber have no conflict of interest or financial ties to disclose.
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Aksoy, E., Taskin, H.E., Aliyev, S. et al. Robotic versus laparoscopic adrenalectomy in obese patients. Surg Endosc 27, 1233–1236 (2013). https://doi.org/10.1007/s00464-012-2580-1
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DOI: https://doi.org/10.1007/s00464-012-2580-1