Robot-assisted vs laparoscopic lateral transabdominal adrenalectomy: a propensity score matching analysis

• Published in: Surgical endoscopy Vol. 36; no. 11; pp. 8619 - 8629
• Main Authors: De Crea, Carmela, Pennestrì, Francesco, Voloudakis, Nikolaos, Sessa, Luca, Procopio, Priscilla Francesca, Gallucci, Pierpaolo, Bellantone, Rocco, Raffaelli, Marco
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-11-2022; Springer Nature B.V
• Subjects: 2022 EAES Oral; Abdominal Surgery; Adrenal Gland Neoplasms - pathology; Adrenal Gland Neoplasms - surgery; Adrenalectomy - adverse effects; Adrenalectomy - methods; Body mass index; Clinical medicine; Endoscopy; Gastroenterology; Gynecology; Hepatology; Humans; Laparoscopy; Laparoscopy - methods; Medicine; Medicine & Public Health; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Proctology; Propensity Score; Retrospective Studies; Robotic surgery; Robotics; Surgery; Treatment Outcome; Tumors; Laparoscopic adrenalectomy; Lateral transabdominal adrenalectomy; Robot-assisted adrenalectomy; Postoperative complications; Outcomes
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-022-09663-3

Background
Laparoscopic adrenalectomy (LA) is the gold standard treatment for adrenal lesions. Robot-assisted adrenalectomy (RAA) is a safe approach, associated with higher costs in absence of clear-cut benefits. Several series reported some advantages of RAA over LA in challenging cases, but definitive conclusions are lacking. We evaluated the cost effectiveness and outcomes of robotic (R-LTA) and laparoscopic (L-LTA) approach for lateral transabdominal adrenalectomy in a high-volume center.
Methods
Among 356 minimally invasive adrenalectomies (January 2012–August 2021), 286 were performed with a lateral transabdominal approach: 191 L-LTA and 95 R-LTA. The R-LTA and L-LTA patients were matched for lesion side and size, hormone secretion, and BMI with propensity score matching (PSM) analysis. Postoperative complications, operative time (OT), postoperative stay (POS), and costs were compared.
Results
PSM analysis identified 184 patients, 92 in R-LTA and 92 in L-LTA group. The two groups were well matched. The median lesion size was 4 cm in both groups (
p
 = 0.533). Hormonal hypersecretion was detected in 55 and 54 patients of R-LTA and L-LTA group, respectively (
p
 = 1). Median OT was significantly longer in R-LTA group (90.0 vs 65.0 min) (
p 
< 0.001). No conversion was registered. Median POS was similar (4.0 vs 3.0 days in the R-LTA and L-LTA) (
p
 = 0.467). No difference in postoperative complications was found (
p
 = 1). The cost margin analysis showed a positive income for both procedures (3137 vs 3968 € for R-LTA and L-LTA). In the multiple logistic regression analysis, independent risk factors for postoperative complications were hypercortisolism (OR = 3.926,
p
 = 0.049) and OT > 75 min (OR = 8.177,
p
 = 0.048).
Conclusions
The postoperative outcomes of R-LTA and L-TLA were similar in our experience. Despite the higher cost, RAA appears to be cost effective and economically sustainable in a high-volume center (60 adrenalectomies/year), especially if performed in challenging cases, including patients with large (> 6 cm) and/or functioning tumors.
Graphical abstract