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Robotic-assisted unilateral adrenalectomy: risk factors for perioperative complications in 303 consecutive patients

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Abstract

Background

There is no consensus about the utility of using the robotic platform to perform a unilateral lateral transabdominal adrenalectomy in comparison with conventional laparoscopy. In some groups, obese patients (Body Mass Index > 30 kg/m2) and patients with tumor size > 5 cm have been considered as good candidates for robotic adrenalectomy. However, evaluation of incidence and risk factors for perioperative complications is currently lacking in large series of patients. The aim of this study was to evaluate incidence and predictive factors for intraoperative (conversion and capsular rupture) and postoperative complications (morbidity) after unilateral robotic-assisted transabdominal lateral adrenalectomy.

Methods

From 2001 to 2016, consecutive patients undergoing unilateral lateral transabdominal robotic adrenalectomy were included in a prospectively maintained database and analyzed retrospectively (clinicaltrials.gov NCT03410394).

Results

A total of 303 consecutive patients were analyzed. Between the first and last 100 of patients, mean tumor size increased from 2.9 to 4.2 cm (p < 0.001) and mean operating time decreased from 99 to 77 min (p < 0.001). Postoperative complications occurred in 28 patients (9.2%) and no postoperative death was observed. Nine patients (3%) were converted to open laparotomy and capsular rupture was observed in nine patients (3%). BMI was not a significant risk factor for conversion, capsular rupture, or postoperative complication. Tumor size > 5 cm remained the only predictive factor for conversion to laparotomy (OR 7.47, 95% CI 1.81–30.75; p = 0.005). History of upper gastrointestinal surgery was the only predictive factor for capsular rupture (OR 13.6, 95% CI 2.33–80.03; p = 0.004). Conversion to laparotomy (OR 8.35, 95% CI 1.99–35.05; p = 0.003) and patient age (OR 1.039, 95% CI 1.006–1.072; p = 0.019) remained independent predictive factors for postoperative complications.

Conclusions

This study identified independent risk factors for perioperative complications after robotic-assisted unilateral adrenalectomy. These factors should be taken into account when evaluating robotic-assisted transabdominal lateral adrenalectomy.

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References

  1. Bittner JG, Gershuni VM, Matthews BD, Moley JF, Brunt LM (2013) Risk factors affecting operative approach, conversion, and morbidity for adrenalectomy: a single-institution series of 402 patients. Surg Endosc 27:2342–2350

    Article  PubMed  Google Scholar 

  2. Coste T, Caiazzo R, Torres F, Vantyghem MC, Carnaille B, Pattou F et al (2017) Laparoscopic adrenalectomy by transabdominal lateral approach: 20 years of experience. Surg Endosc 31:2743–2751

    Article  PubMed  Google Scholar 

  3. Gaujoux S, Bonnet S, Leconte M, Zohar S, Bertherat J, Bertagna X et al (2011) Risk factors for conversion and complications after unilateral laparoscopic adrenalectomy. Br J Surg 98:1392–1399

    Article  CAS  PubMed  Google Scholar 

  4. Hattori S, Miyajima A, Maeda T, Hasegawa M, Takeda T, Kosaka T et al (2012) Risk factors for perioperative complications of laparoscopic adrenalectomy including single-site surgery. J Endourol 26:1463–1467

    Article  PubMed  Google Scholar 

  5. Shen WT, Sturgeon C, Duh QY (2005) From incidentaloma to adrenocortical carcinoma: the surgical management of adrenal tumors. J Surg Oncol 89:186–192

    Article  PubMed  Google Scholar 

  6. Aksoy E, Taskin H, Aliyev S, Mitchell J, Siperstein A, Berber E (2013) Robotic versus laparoscopic adrenalectomy in obese patients. Surg Endosc 27:1233–1236

    Article  PubMed  Google Scholar 

  7. Brandao LF, Autorino R, Laydner H, Haber GP, Ouzaid I, De Sio M et al (2014) Robotic versus laparoscopic adrenalectomy: a systematic review and meta-analysis. Eur Urol 65:1154–1161

    Article  PubMed  Google Scholar 

  8. Brunaud L, Ayav A, Zarnegar R, Rouers A, Klein M, Boissel P, Bresler L (2008) Prospective evaluation of 100 robotic-assisted unilateral adrenalectomies. Surgery 144:995–1001

    Article  PubMed  Google Scholar 

  9. Morelli L, Tartaglia D, Bronzoni J, Palmeri M, Guadagni S, Di Franco G et al (2016) Robotic assisted versus pure laparoscopic surgery of the adrenal glands: a case-control study comparing surgical techniques. Langenbecks Arch Surg 401:999–1006

    Article  PubMed  Google Scholar 

  10. Tang K, Li H, Xia D, Yu G, Guo X, Guan W, Xu H, Ye Z (2015) Robot-assisted versus laparoscopic adrenalectomy: a systematic review and meta-analysis. Surg Laparosc Endosc Percutan Tech 25:187 – 95

    Google Scholar 

  11. Economopoulos KP, Mylonas K, Stamou AA, Theocharidis V, Sergentanis TN, Psaltopoulou T, Richards ML (2017) Laparoscopic versus robotic adrenalectomy: a comprehensive meta-analysis. Int J Surg 38:95–104

    Article  PubMed  Google Scholar 

  12. 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 195:433–438

    Article  PubMed  Google Scholar 

  13. Zografos GN, Farfaras A, Vasiliadis G, Pappa T, Aggeli C, Vassilatou E, Kaltsas G, Piaditis G (2010) Laparoscopic resection of large adrenal tumors. JSLS 14:364–368

    Article  PubMed  PubMed Central  Google Scholar 

  14. Societe francaise d’anesthesie et de réanimation (SFAR) (2011) Antibioprophylaxis in surgery and interventional medicine (adult patients). Ann Fr Anesth Reanim 30:168–190

    Article  Google Scholar 

  15. Nomine-Criqui C, Brunaud L, Germain A, Klein M, Cuny T, Ayav A, Bresler L (2015) Robotic lateral transabdominal adrenalectomy. J Surg Oncol 112:305–309

    Article  PubMed  Google Scholar 

  16. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kahramangil B, Berber E (2017) Comparison of posterior retroperitoneal and transabdominal lateral approaches in robotic adrenalectomy: an analysis of 200 cases. Surg Endosc. https://doi.org/10.1007/s00464-017-5894-1

    Article  PubMed  Google Scholar 

  18. Wang TS, Duh QY (2018) Volume-outcome relationship in adrenal surgery. Surgery 163:165–166

    Article  PubMed  Google Scholar 

  19. McCulloch P, Altman DG, Campbell WB, Flum DR, Glasziou P, Marshall JC et al (2009) No surgical innovation without evaluation: the IDEAL recommendations. Lancet 374:1105–1112

    Article  Google Scholar 

  20. 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 7:27–32

    Article  CAS  PubMed  Google Scholar 

  21. Lee CW, Salem AI, Schneider DF, Leverson GE, Tran TB, Poultsides GA et al (2017) Minimally invasive resection of adrenocortical carcinoma: a Multi-Institutional Study of 201 patients. J Gastrointest Surg 21:352–362

    Article  PubMed  Google Scholar 

  22. Morris L, Ituarte P, Zarnegar R, Duh QY, Ahmed L, Lee J, Inabnet W 3rd, Meyer-Rochow G, Sidhu S, Sywak M, Yeh M (2008) Laparoscopic adrenalectomy after prior abdominal surgery. World J Surg 32:897–903

    Article  PubMed  Google Scholar 

  23. Gaujoux S, Mihai R, Joint Working Group of ESES and ENSAT (2017) European Society of Endocrine Surgeons (ESES) and European Network for the Study of Adrenal Tumours (ENSAT) recommendations for the surgical management of adrenocortical carcinoma. Br J Surg 104:358–376

    Article  CAS  PubMed  Google Scholar 

  24. Li ML, Fitzgerald PA, Price DC, Norton JA (2001) Iatrogenic pheochromocytomatosis: a previously unreported result of laparoscopic adrenalectomy. Surgery 130:1072–1077

    Article  CAS  PubMed  Google Scholar 

  25. Lairmore TC, Folek J, Govednik CM, Snyder SK (2016) Improving minimally invasive adrenalectomy: selection of optimal approach and comparison of outcomes. World J Surg 40:1625–1631

    Article  PubMed  Google Scholar 

  26. Maker AV, Maker VK (2017) Techniques to perform robotic left adrenalectomy in the obese patient. Surg Endosc 31:950–951

    Article  PubMed  Google Scholar 

  27. Morino M, Beninca G, Giraudo G, Del Genio GM, Rebecchi F, Garrone C (2004) Robot-assisted vs laparoscopic adrenalectomy: a prospective randomized controlled trial. Surg Endosc 18:1742–1746

    Article  CAS  PubMed  Google Scholar 

  28. Brunaud L (2013) Should all new surgical procedures be published ? J Visc Surg 150:163–164

    Article  CAS  PubMed  Google Scholar 

Download references

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Authors and Affiliations

  1. Centre Hospitalier Universitaire (CHU) Nantes-Hôtel Dieu, Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Institut des Maladies del’Appareil Digestif (IMAD), Place Alexis Ricordeau, 44093, Nantes, France

    Tristan Greilsamer

  2. Université de Lorraine, Service de Chirurgie Digestive, Hépatobiliaire, Pancréatique, Endocrinienne et Cancérologique, Centre Hospitalier Régional Universitaire (CHRU) Nancy-Brabois, Rue du Morvan, 54511, Vandoeuvre-Les-Nancy, France

    Claire Nomine-Criqui, Laurent Bresler & Laurent Brunaud

  3. Hôpitaux Universitaires Paris Nord Val-de-Seine, Service d’Anesthésie et de Réanimation Chirurgicale, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018, Paris, France

    Michaël Thy

  4. Department of Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, NY, USA

    Timothy Ullmann & Rasa Zarnegar

  5. Faculty of Medicine, Université de Lorraine, University de Lorraine, INSERM U954, Nancy, France

    Laurent Brunaud

Authors
  1. Tristan Greilsamer
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  2. Claire Nomine-Criqui
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  5. Rasa Zarnegar
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  6. Laurent Bresler
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  7. Laurent Brunaud
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Corresponding author

Correspondence to Laurent Brunaud.

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Disclosures

Laurent Bresler is proctor for Intuitive Surgical Inc (pelvic floor procedures). Tristan Greilsamer, Claire Nomine-Criqui, Michaël Thy, Timothy Ullmann, Rasa Zarnegar, and Laurent Brunaud declare that they have no conflicts of interest or financial ties to disclose.

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Greilsamer, T., Nomine-Criqui, C., Thy, M. et al. Robotic-assisted unilateral adrenalectomy: risk factors for perioperative complications in 303 consecutive patients. Surg Endosc 33, 802–810 (2019). https://doi.org/10.1007/s00464-018-6346-2

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  • DOI: https://doi.org/10.1007/s00464-018-6346-2

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