Robotic adrenalectomy: technical aspects, early results and learning curve.
BACKGROUND
Adrenal surgery is undergoing continuous evolution, and robotic technology may extend indications for a minimally invasive approach to adrenalectomy.


METHODS
Thirty robot-assisted unilateral transperitoneal adrenalectomy procedures have been performed at our Department over the last 5 years. The presence of bilateral lesions and vascular involvement were the only contra-indications for a minimally invasive approach. Several patients presented with significant co-morbidities: BMI > 35 kg/m(2) (20%); ASA score III-IV (58.7%); and moderate to severe impaired respiratory function (36.6%). In addition, 40% of patients had undergone previous abdominal surgery.


RESULTS
Two patients presented with intra-operative complications (6.6%) and only one patient required conversion to an open procedure (3.3%). None of the patients required intraoperative transfusions. Hospital morbidity was 10% but no mortality was recorded. The mean hospital stay was 5.2 ± 2.2 days. The mean size of the resected adrenal mass was 5.1 ± 2.4 cm. A significant reduction in operative times was found with gaining experience.


CONCLUSIONS
Thanks to robotic technology, some subpopulations of patients with clinical or oncological contra-indications to laparoscopic treatment may be addressed with minimally invasive treatment.
Minimally Invasive and Robotic Surgical Unit, San Giovanni-Addolorata Hospital, Rome, Italy.
Annibale
A
D'Annibale
Giorgio
G
Lucandri
Igor
I
Monsellato
Monica
M
De Angelis
Graziano
G
Pernazza
Giovanni
G
Alfano
Paolo
P
Mazzocchi
Vito
V
Pende
D000310:Adrenal Gland Neoplasms / Q000601:surgery; D000315:Adrenalectomy / Q000009:adverse effects / Q000193:education / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000193:education / Q000379:methods; D061646:Operative Time; D012371:Robotics / Q000193:education / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000193:education / Q000379:methods*; D016896:Treatment Outcome