Robotic versus laparoscopic adrenalectomy in obese patients.
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/m(2)) 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 χ(2) 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/m(2), 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.
Division of Endocrine Surgery, Robotic Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, 9500 Euclid Avenue/F20, Cleveland, OH 44195, USA.
Erol
E
Aksoy
Halit Eren
HE
Taskin
Shamil
S
Aliyev
Jamie
J
Mitchell
Allan
A
Siperstein
Eren
E
Berber
D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011446:Prospective Studies; D012371:Robotics