title: Robotic assisted versus pure laparoscopic surgery of the adrenal glands: a case-control study comparing surgical techniques.
abstract: OBJECTIVE
  The role of the da Vinci Robotic System®in adrenal gland surgery is not yet well defined. The goal of this study was to compare robotic-assisted surgery with pure laparoscopic surgery in a single center.
  
  
  METHODS
  One hundred and 16 patients underwent minimally invasive adrenalectomies in our department between June 1994 and December 2014, 41 of whom were treated with a robotic-assisted approach (robotic adrenalectomy, RA). Patients who underwent RA were matched according to BMI, age, gender, and nodule dimensions, and compared with 41 patients who had undergone laparoscopic adrenalectomies (LA). Statistical analysis was performed using the Student's t test for independent samples, and the relationship between the operative time and other covariates were evaluated with a multivariable linear regression model. P < 0.05 was considered significant.
  
  
  RESULTS
  Mean operative time was significantly shorter in the RA group compared to the LA group. The subgroup analysis showed a shorter mean operative time in the RA group in patients with nodules ≥6 cm, BMI ≥ 30 kg/m2and in those who had previous abdominal surgery (p < 0.05). Results from the multiple regression model confirmed a shorter mean operative time with RA with nodules ≥6 cm (p = 0.010). Conversion rate and postoperative complications were 2.4 and 4.8 % in the LA group and 0 and 4.8 % in the RA group.
  
  
  CONCLUSIONS
  In our experience, RA shows potential benefits compared to classic LA, in particular on patients with nodules ≥6 cm, BMI ≥ 30 kg/m2, and with previous abdominal surgery.
authors: General Surgery Unit, Department of Oncology, Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy. luca.morelli@unipi.it.|EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy. luca.morelli@unipi.it.
authors: Luca
authors: L
authors: Morelli
authors: General Surgery Unit, Department of Oncology, Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors: Dario
authors: D
authors: Tartaglia
authors: General Surgery Unit, Department of Oncology, Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors: Jessica
authors: J
authors: Bronzoni
authors: General Surgery Unit, Department of Oncology, Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors: Matteo
authors: M
authors: Palmeri
authors: General Surgery Unit, Department of Oncology, Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors: Simone
authors: S
authors: Guadagni
authors: General Surgery Unit, Department of Oncology, Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors: Gregorio
authors: G
authors: Di Franco
authors: General Surgery Unit, Department of Oncology, Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors: Andrea
authors: A
authors: Gennai
authors: General Surgery Unit, Department of Oncology, Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors: Matteo
authors: M
authors: Bianchini
authors: Institute of Clinical Physiology, National Council of Research, Pisa, Italy.
authors: Luca
authors: L
authors: Bastiani
authors: EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy.
authors: Andrea
authors: A
authors: Moglia
authors: EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy.
authors: Vincenzo
authors: V
authors: Ferrari
authors: Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.
authors: Enza
authors: E
authors: Fommei
authors: Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors: Andrea
authors: A
authors: Pietrabissa
authors: General Surgery Unit, Department of Oncology, Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors: Giulio
authors: G
authors: Di Candio
authors: EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy.
authors: Franco
authors: F
authors: Mosca
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome
keywords: Case-matched study; Laparoscopy; Retrospective; Robotics; Total adrenalectomy